Shembel Adrianna C, Mau Ted, Zafereo Jason, Morrison Robert, Crocker Caroline, Moore Avery, Khan Arlin
Department of Otolaryngology - Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas; School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, Texas.
Department of Otolaryngology - Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
J Voice. 2024 Aug 30. doi: 10.1016/j.jvoice.2024.08.003.
Primary muscle tension dysphonia (pMTD) is a functional voice disorder that reduces communicative abilities and adversely impacts occupational productivity and quality of life. Patients with pMTD report increased vocal effort, fatigue, discomfort, and odynophonia. Although laryngeal and paralaryngeal muscle tension and hyperfunction are the most commonly proposed mechanisms underlying these symptoms, recent studies suggest pMTD may have more to do with the somatosensory system. However, relationships between voice symptoms and somatosensory mechanisms are poorly understood, creating challenges for mechanistic-based pMTD management. The first objective was to compare laryngeal, paralaryngeal, and global somatosensation between subjects with and without pMTD. The second was to determine relationships between pMTD symptoms and somatosensation.
Fifty-two (20 pMTD and 32 control) subjects underwent laryngeal sensory testing with aesthesiometers, as well as peripheral mechanosensory and dynamic temporal summation testing to paralaryngeal and limb regions. Voice symptom severities (vocal effort, fatigue, discomfort, and odynophonia) were collected on 100-mm visual analog scales before and after laryngeal sensory testing. Participants also completed the Central Sensitization Inventory.
Patients with pMTD reported significantly higher laryngeal sensations (P = 0.0072) and voice symptom severities (P < 0.001) compared with the control group, and had significantly more vocal tract discomfort postlaryngeal sensory testing compared with the prelaryngeal sensory testing timepoint (P = 0.0023). However, there were no significant group differences in laryngeal airway protection responses suggestive of peripheral laryngeal hypersensitivities (P = 0.444). There were also no significant group differences on paralaryngeal or global sensitivities (P > 0.05), and no correlations between severity of voice symptoms and perceptual laryngeal sensations or hypersensitivities (P > 0.05).
Patients with pMTD perceive more sensitivities in the larynx and feel more sensations related to the voice (vocal effort, fatigue, discomfort, and pain). However, in general, patients with pMTD do not have abnormal peripheral laryngeal hypersensitivities, increased global somatosensation, or heightened central sensitivity. The lack of significant correlations between peripheral laryngeal hypersensitivities and voice symptom severity ratings suggests these outcome variables target distinct mechanistic constructs.
原发性肌肉紧张性发音障碍（pMTD）是一种功能性嗓音障碍，会降低沟通能力，并对职业生产力和生活质量产生不利影响。患有pMTD的患者报告称发声费力、疲劳、不适和发声疼痛有所增加。尽管喉肌和喉旁肌紧张及功能亢进是这些症状最常被提出的潜在机制，但最近的研究表明，pMTD可能与躯体感觉系统有更大关系。然而，嗓音症状与躯体感觉机制之间的关系尚不清楚，这给基于机制的pMTD管理带来了挑战。第一个目标是比较患有和未患有pMTD的受试者之间的喉部、喉旁和整体躯体感觉。第二个目标是确定pMTD症状与躯体感觉之间的关系。
52名受试者（20名患有pMTD，32名作为对照）接受了用触觉测量仪进行的喉部感觉测试，以及对喉旁和肢体区域的外周机械感觉和动态时间总和测试。在喉部感觉测试前后，用100毫米视觉模拟量表收集嗓音症状严重程度（发声费力、疲劳、不适和发声疼痛）。参与者还完成了中枢敏化量表。
与对照组相比，患有pMTD的患者报告喉部感觉明显更高（P = 0.0072），嗓音症状严重程度更高（P < 0.001），并且与喉部感觉测试前的时间点相比，喉部感觉测试后声道不适明显更多（P = 0.0023）。然而，在提示外周喉部超敏反应的喉部气道保护反应方面，两组之间没有显著差异（P = 0.444）。在喉旁或整体敏感性方面，两组之间也没有显著差异（P > 0.05），嗓音症状严重程度与喉部感觉或超敏反应的感知之间也没有相关性（P > 0.05）。
患有pMTD的患者在喉部感觉到更高的敏感性，并且感觉到更多与嗓音相关的感觉（发声费力、疲劳、不适和疼痛）。然而，总体而言，患有pMTD的患者没有外周喉部超敏反应异常、整体躯体感觉增加或中枢敏感性增强。外周喉部超敏反应与嗓音症状严重程度评分之间缺乏显著相关性，表明这些结果变量针对不同的机制结构。
