Moore Avery, Shembel Adrianna C
School of Behavioral and Brain Sciences, Department of Speech, Language, and Hearing, Callier Center for Communication Disorders, University of Texas at Dallas, Richardson, TX.
School of Behavioral and Brain Sciences, Department of Speech, Language, and Hearing, Callier Center for Communication Disorders, University of Texas at Dallas, Richardson, TX; Department of Otolaryngology - Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
J Voice. 2025 Jan 3. doi: 10.1016/j.jvoice.2024.12.020.
Patients with primary muscle tension dysphonia (pMTD) commonly report symptoms of vocal effort, fatigue, discomfort, odynophonia, and aberrant vocal quality (eg, vocal strain, hoarseness). However, voice symptoms most salient to pMTD have not been identified. Furthermore, how standard vocal fatigue and vocal tract discomfort indices that capture persistent symptoms-like the Vocal Fatigue Index (VFI) and Vocal Tract Discomfort Scale (VTDS)-relate to acute symptoms experienced at the time of the voice evaluation is unclear. Finally, correlations between voice symptoms and acoustic vocal quality are poorly understood. As such, the objectives of this study were to: (1) identify the most salient pMTD symptoms, (2) correlate the VFI and VTDS with acute voice symptom severity, and (3) better understand relationships between voice symptom experiences and vocal acoustics.
Thirty subjects (15 pMTD, 15 controls) rated their vocal effort, vocal fatigue, vocal tract discomfort, odynophonia, and vocal quality on separate 100 mm visual analog scales (VAS) and completed the VFI-Part1 and VTDS. Cepstral peak prominences (CPP) were obtained from voice recordings of sustained /i/ and the all-voiced consensus of auditory-perceptual evaluation of voice (CAPE-V) sentence.
Patients with pMTD reported significantly higher severities of vocal effort (P < 0.0001), fatigue (P = 0.001), and discomfort (P = 0.0008) and scored significantly higher on both vocal indices (VFI-Part1: P < 0.0001; VTDS: P = 0.0056) compared to vocally healthy controls. Both indices had medium-to-high correlations with acute symptom severities in both groups. However, there were no significant differences between groups on odynophonia severity (P = 0.349), acoustic vocal quality (/i/: P = 1.00, CAPE-V: P = 0.228) or self-perceptual vocal quality (P = 0.141). There were also no significant relationships between vocal acoustics and patient symptoms or between vocal acoustics and standard vocal fatigue and vocal tract discomfort indices (P's > 0.05).
Somatosensory symptoms of vocal effort, vocal fatigue, and vocal tract discomfort are the most salient clinical features in patients with pMTD. Standard voice indices that capture more chronic symptoms can also reliably capture symptoms experienced at the time of the voice evaluation in patients with pMTD. Although odynophonia and aberrant acoustic vocal quality may be present in some patients with pMTD, they do not appear to be symptoms central to the condition. Because somatosensory experiences are more salient than vocal quality and vocal acoustics in pMTD, somatosensory symptoms of vocal effort, fatigue, and discomfort should hold more weight during the voice evaluation when pMTD is suspected.
原发性肌肉紧张性发声障碍（pMTD）患者通常报告有发声费力、疲劳、不适、发声疼痛及异常嗓音质量（如发声紧张、嘶哑）等症状。然而，尚未确定对pMTD最为突出的嗓音症状。此外，像嗓音疲劳指数（VFI）和声道不适量表（VTDS）这类用于捕捉持续性症状的标准嗓音疲劳和声道不适指标，与嗓音评估时所经历的急性症状之间的关系尚不清楚。最后，对于嗓音症状与声学嗓音质量之间的相关性了解甚少。因此，本研究的目的是：（1）确定最突出的pMTD症状；（2）将VFI和VTDS与急性嗓音症状严重程度相关联；（3）更好地理解嗓音症状体验与嗓音声学之间的关系。
30名受试者（15名pMTD患者，15名对照者）在单独的100毫米视觉模拟量表（VAS）上对其发声费力、嗓音疲劳、声道不适、发声疼痛及嗓音质量进行评分，并完成VFI - Part1和VTDS。从持续发/i/音的嗓音录音中获取谐波峰值突出度（CPP），并对嗓音进行听觉 - 感知评估的全嗓音共识（CAPE - V）句子评估。
与嗓音健康的对照者相比，pMTD患者报告的发声费力（P < 0.0001）、疲劳（P = 0.001）和不适（P = 0.0008）严重程度显著更高，并且在两个嗓音指标上的得分也显著更高（VFI - Part1：P < 0.0001；VTDS：P = 0.0056）。两个指标与两组的急性症状严重程度均具有中到高度的相关性。然而，两组在发声疼痛严重程度（P = 0.349）、声学嗓音质量（/i/音：P = 1.00，CAPE - V：P = 0.228）或自我感知的嗓音质量（P = 0.141）方面没有显著差异。在嗓音声学与患者症状之间，以及嗓音声学与标准嗓音疲劳和声道不适指标之间也没有显著关系（P > 0.05）。
发声费力、嗓音疲劳和声道不适的躯体感觉症状是pMTD患者最突出的临床特征。能够捕捉更多慢性症状的标准嗓音指标也能够可靠地捕捉pMTD患者在嗓音评估时所经历的症状。尽管一些pMTD患者可能存在发声疼痛和异常声学嗓音质量，但它们似乎并非该病症的核心症状。由于在pMTD中躯体感觉体验比嗓音质量和嗓音声学更为突出，当怀疑有pMTD时，在嗓音评估中发声费力、疲劳和不适的躯体感觉症状应具有更大的权重。
