Brain Mapping of Voice Control
This study is currently recruiting patients.
Purpose
Some voice disorders are caused by uncontrolled muscle actions that affect the larynx or voice box.
The purpose of this study is to understand 1) how the brain controls voice production; 2) how changes in sensation within
the voice box affect brain control of the voice box; 3) how the central nervous system is affected when people have motor
or sensory abnormalities that affect the voice box; and 4) whether patients with voice disorders differ from people without
voice disorders in the way the brain controls the voice box. By better understanding these concepts, researchers hope to
develop improved treatments for patients with voice disorders.
Forty-five healthy adult volunteers and 90 patients with voice disorders will participate in this study. Participants must
be between the ages of 20 and 70. The study will involve two visits to the Clinical Center. During the first visit, participants
will undergo a medical history and physical exam. During the second visit, investigators will perform the following procedures
on study participants: 1) look at the voice box with a nasolaryngoscope, a fine tube through the nose; 2) use MRI [magnetic
resonance imaging] to record brain activity while participants use their voice to speak; 3) changing sensation in the voice
box by dripping a topical anesthetic onto the vocal folds; and 4) using MRI to again record brain activity during speech immediately
after applying the topical anesthetic.
Participants will receive up to $300 in compensation for their involvement in this study.
Condition
|
Voice Disorders
|
MedlinePlus related topics: Voice Disorders
Study Type: Observational
Study Design: Natural History
Official Title: Functional Brain Mapping of Laryngeal Sensorimotor Control in Voice Disorders
Further Study Details:
Expected Total Enrollment:
160
Study start: August 2, 2003
The neural organization of laryngeal motor and somatosensory function will be investigated in adults with idiopathic voice
disorders using functional magnetic resonance imaging. Brain activation will be compared in normal volunteers and patients
with spasmodic dysphonia (SD), muscle tension dysphonia (MTD) and vocal tremor. While each voice disorder is characterized
by strained vocalization, the disorders are distinguished by other differences in voice symptoms. Accordingly, the brain
correlates of vocalization in these disorders may both differ from each other and that of normal vocal function. Because
sensory feedback has been identified as a factor in SD, the role of afferent input in vocalization will be investigated by
comparing brain activation before and after topical anesthesia of the laryngeal mucosa. The afferent blockade is expected
to significantly suppress dysphonic symptoms in SD patients for the duration of the block.
The change in symptomatology may be associated with a temporary but significant change in central sensorimotor patterns in
these patients. The block is not expected to alter MTD, vocal tremor or normal vocal function. The brain activation changes
that accompany symptom relief in SD patients will determine alterations in central neural control that have a role in symptom
generation in SD. Identifying these differences in central sensorimotor control between the disorders will provide insight
into their differences in pathophysiology.
Eligibility
Genders Eligible for Study:
Both
Accepts Healthy Volunteers
INCLUSION CRITERIA:
The inclusion criteria for normal volunteers are normal vocal function and average health as determined by the staff otolaryngologist.
Normal vocal function refers to normal voice quality, a negative history for voice or laryngeal disorders. Persons with
significant pulmonary, neurological and psychiatric function will not be recruited. The primary inclusion criteria for the
voice disordered groups are a current diagnosis of spasmodic dysphonia (abductor or adductor type), muscular tension dysphonia
or voice tremor. These persons will not have pulmonary, neurological or psychiatric disorders or exclusion criteria.
INCLUSION CRITERIA - for Patients with Spasmodic Dysphonia:
Intermittent strained hoarseness, uncontrolled voice breaks or changes in pitch are present during vowels, liquids (r & l)
and semi-vowels (w & y), during speech for adductor SD or prolonged voiceless consonants producing breathy breaks for abductor
SD;
Less prominent symptoms during whisper, singing or falsetto,
Normal voice and vocal fold movement for protective and emotional laryngeal function, such as cough, laugh or cry;
A diagnosis of adductor or adductor spasmodic dysphonia based on voice testing and fiberoptic nasolaryngoscopy by a board
certified otolaryngologist and Speech-Language Pathologist during the initial interview;
Exclusion of other laryngeal pathologies based on a fiberoptic nasolaryngoscopic examination conducted during the initial
interview by the staff otolaryngologist.
INCLUSION CRITERIA - for Patients with Muscular Tension Dysphonia:
Increased phonatory muscle tension in the paralaryngeal and suprahyoid muscles on palpation;
A consistent hypertonic laryngeal posture for phonation, such as either an anterior-posterior squeeze (pin-hole posture) or
ventricular hyper adduction and an absence of SD or vocal tremor as determined by a Speech-Language Pathologist and the staff
otolaryngologist;
Exclusion of other laryngeal pathologies based on a fiberoptic nasolaryngoscopic examination conducted during the initial
interview by the staff otolaryngologist.
INCLUSION CRITERIA - for Patients with Vocal Tremor:
Vocal tremor during vocalization that primarily involves laryngeal structures;
Exclusion of other laryngeal pathologies based on a fiberoptic nasolaryngoscopic examination conducted during the initial
interview by the staff otolaryngologist. All participants will receive a nasolaryngoscopic screening examination.
EXCLUSION CRITERIA:
Any individual with a history of one or more of the following contraindications will be excluded from the study:
Airway obstruction, smoking or tobacco use;
Pulmonary, or neurological disease;
Pregnancy as reported by the volunteer or a positive pregnancy result from a urine sample obtained on the day of testing;
Psychiatric disorder, under psychiatric care, or on medication for psychiatric disorders. Examples of psychiatric disorders
to be excluded are: somatoform disorders, conversion disorders, major depression, schizophrenia or a bipolar disorder. A
history of a previous episode of minor reactive depression would not exclude a person from participation;
Speech or hearing problems as determined by medical history and examination by the otolaryngologist. A 30 dB HL hearing screening
between 500 and 3000 Hz will be conducted if subjects report difficulty following spoken instructions or significant noise
exposure;
A reduction in the range of vocal fold movement during non-speech tasks such as whistling suggesting either paralysis or paresis,
joint abnormality or neoplasm as determined by videolaryngoscopic examination by the staff otolaryngologist;
Complete aphonia, a history of airway obstruction or structural abnormalities affect the larynx such as vocal fold nodules,
polyps, carcinoma, cysts, contact ulcers, chronic laryngitis as determined by videolaryngoscopic examination by the staff
otolaryngologist;
Individuals having any condition that would present unnecessary risk to them, e.g., claustrophobia.
Specific contraindications for magnetic resonance imaging include: i) Any implant or surgical clip - implanted neural stimulator,
implanted cardiac pacemaker or autodefibrillator, cochlear implant, ocular implant, aneurysm clip, artificial heart valve,
insulin pump, orthopedic pins or prosthesis; ii) Any ferromagnetic foreign body - metal shavings, shrapnel, orthodontic braces,
certain tattoos or permanent eye liner; and, iii) Any other implanted device or foreign body not listed above that is possibly
ferromagnetic.
Location
and Contact
Information
Maryland National Institute of Neurological Disorders and Stroke (NINDS), 9000 Rockville Pike,
Bethesda,
Maryland,
20892,
United States; Recruiting
Patient Recruitment and Public Liaison Office
1-800-411-1222
prpl@mail.cc.nih.gov
TTY
1-866-411-1010
More Information
Detailed Web Page
Publications
Ludlow CL, Schulz GM, Yamashita T, Deleyiannis FW. Abnormalities in long latency responses to superior laryngeal nerve stimulation
in adductor spasmodic dysphonia. Ann Otol Rhinol Laryngol. 1995 Dec;104(12):928-35.
Dworkin JP, Meleca RJ, Simpson ML, Garfield I. Use of topical lidocaine in the treatment of muscle tension dysphonia. J
Voice. 2000 Dec;14(4):567-74.
Jurgens U. Neural pathways underlying vocal control. Neurosci Biobehav Rev. 2002 Mar;26(2):235-58. Review.
Study ID Numbers:
030260; 03-N-0260
Record last reviewed:
June 30, 2004
Last Updated:
June 30, 2004
Record first received:
August 6, 2003
ClinicalTrials.gov Identifier:
NCT00066911Health Authority: United States: Federal Government
ClinicalTrials.gov processed this record on 2004-11-08