Voice disorders affect millions of Americans and have been targeted as a national priority for investigation. The impact of voice disorders on quality of life is significant; the ability to work, relate to friends and family, participate in social activties, and simply engage in everyday life becomes effortful, if not impossible, when one's voice is impaired. The multi-factorial nature of voice disorders necessitates that clinicians understand how the larynx functions in order to make appropriate treatment decisions. During phonation, the larynx serves as an energy transducer, transferring aerodynamic energy in the form of subglottal pressure (Ps) and airflow into acoustic energy in the form of sound. Noninvasive aerodynamic assessment is an objective and quantitative method of evaluating the inputs to voice production. The proposed research has two interrelated parts. In part I, research will focus on improving three methods of aerodynamic measurement developed in our laboratory: airflow interruption; incomplete airflow interruption; and airflow redirection. These methods have all been demonstrated to be accurate. Modifications will be made to the devices to allow for measurement of phonation threshold flow and phonation threshold power, two new parameters proposed by our laboratory that have been experimentally shown to be valuable. Enhancing these devices with additions such as auditory feedback, visual feedback, cheek restraints, and modified analysis techniques will also be investigated, potentially reducing intrasubject variability. We will also determine the optimal interruption length for measurement of Ps and determine how interruption affects vocal fold vibration by combining our aerodynamic assessment devices with high-speed video imaging. Elicitation of a reflex has hindered the widespread clinical application of airflow interruption. Visualizing the vocal folds during airflow interruption will allow us to determine if this reflex occurs at the larynx and if so, its precise latency. Data from part I will allow for selection of an improved method of aerodynamic assessment. In part II, the optimal system developed in part I will be used to evaluate and compare treatments for common voice disorders. The effect of polyp and nodule size on aerodynamic parameters will be evaluated; how aerodynamic parameters change as lesion size decreases will also be investigated. Pre- and post-treatment aerodynamic assessment will be performed to determine the effect of Botox injections on spasmodic dysphonia. We will also compare several common treatments for vocal fold paralysis. Though numerous treatments are available, an optimal treatment has yet to be developed. Real-time intraoperative measurements of vocal efficiency will be investigated as a means to optimize medialization laryngoplasty and arytenoid adduction. We will also determine the diagnostic power of each aerodynamic parameter individually and all parameters collectively. Preliminary observations suggest that aerodynamic measurements can improve assessment of voice disorders. Thus, the potential to improve understanding of normal and disordered voice production is great.

Public Health Relevance

Voice disorders affect millions of Americans with extensive economic impacts on society and at times debilitating social impacts on individuals. Successful completion of this research will investigate a noninvasive device which can objectively and quantitatively assess voice production in both normal and diseased voices. Clinical implementation of this device will lead to evidence-based treatment of vocal polyps, nodules, spasmodic dysphonia, and vocal fold paralysis.

Agency
National Institute of Health (NIH)
Institute
National Institute on Deafness and Other Communication Disorders (NIDCD)
Type
Research Project (R01)
Project #
5R01DC008153-09
Application #
8917910
Study Section
Motor Function, Speech and Rehabilitation Study Section (MFSR)
Program Officer
Shekim, Lana O
Project Start
2006-04-01
Project End
2017-08-30
Budget Start
2015-09-01
Budget End
2016-08-31
Support Year
9
Fiscal Year
2015
Total Cost
$305,905
Indirect Cost
$95,530
Name
University of Wisconsin Madison
Department
Surgery
Type
Schools of Medicine
DUNS #
161202122
City
Madison
State
WI
Country
United States
Zip Code
53715
Hoffman, Matthew R; Scholp, Austin J; Hedberg, Calvin D et al. (2018) Measurement reliability of phonation threshold pressure in pediatric subjects. Laryngoscope :
Mills, Randal; Hays, Cameron; Al-Ramahi, Jehad et al. (2017) Validation and Evaluation of the Effects of Semi-Occluded Face Mask Straw Phonation Therapy Methods on Aerodynamic Parameters in Comparison to Traditional Methods. J Voice 31:323-328
Devine, Erin E; Hoffman, Matthew R; McCulloch, Timothy M et al. (2017) Evaluation of type II thyroplasty on phonatory physiology in an excised canine larynx model. Laryngoscope 127:396-404
Jiang, Jack J; Hanna, Rewais B; Willey, Malachi V et al. (2016) The Measurement of Airflow Using Singing Helmet That Allows Free Movement of the Jaw. J Voice 30:641-648
Hoffman, Matthew R; Glab, Rachel; Gunderson, McLean et al. (2015) Functional and Histological Evaluation following Canine Vocal Fold Reconstruction Using Composite Thyroid Ala Perichondrium Flaps. Otolaryngol Head Neck Surg 153:79-87
Hoffman, Matthew R; Devine, Erin E; Remacle, Marc et al. (2014) Combined type IIIB with bilateral type I thyroplasty for pitch lowering with maintenance of vocal fold tension. Eur Arch Otorhinolaryngol 271:1621-9
Hoffman, Matthew R; Devine, Erin E; McCulloch, Timothy M et al. (2014) Excised larynx evaluation of wedge-shaped adjustable balloon implant for minimally invasive type I thyroplasty. Laryngoscope 124:942-9
Conroy, Ellen R; Hennick, Terah M; Awan, Shaheen N et al. (2014) Effect of variations to a simulated system of straw phonation therapy on aerodynamic parameters using excised canine larynges. J Voice 28:1-6
Jiang, Jack J; Maytag, Allison L (2014) Aerodynamic measures of glottal function: what extra can they tell us and how do they guide management? Curr Opin Otolaryngol Head Neck Surg 22:450-4
Conroy, Ellen; Surender, Ketan; Geng, Zhixian et al. (2014) Video-based method of quantifying performance and instrument motion during simulated phonosurgery. Laryngoscope 124:2332-7

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