Impaired auditory discrimination and auditory-motor integration in hyperfunctional voice disorders

Abstract

Hyperfunctional voice disorders (HVDs) are the most common class of voice disorders, consisting of diagnoses such as vocal fold nodules and muscle tension dysphonia. These speech production disorders result in effort, fatigue, pain, and even complete loss of voice. The mechanisms underlying HVDs are largely unknown. Here, the auditory-motor control of voice fundamental frequency (fo) was examined in 62 speakers with and 62 speakers without HVDs. Due to the high prevalence of HVDs in singers, and the known impacts of singing experience on auditory-motor function, groups were matched for singing experience. Speakers completed three tasks, yielding: (1) auditory discrimination of voice fo; (2) reflexive responses to sudden fo shifts; and (3) adaptive responses to sustained fo shifts. Compared to controls, and regardless of singing experience, individuals with HVDs showed: (1) worse auditory discrimination; (2) comparable reflexive responses; and (3) a greater frequency of atypical adaptive responses. Atypical adaptive responses were associated with poorer auditory discrimination, directly implicating auditory function in this motor disorder. These findings motivate a paradigm shift for understanding development and treatment of HVDs.

Pitch Discrimination Testing in Patients with a Voice Disorder

“…These results are suggestive of an impairment in auditory discrimination functional (MTVD) and neurological voice-disordered individuals. These data congruent with work by Abur et al [4] who showed that the auditory discrim threshold was significantly larger in patients with hyperfunctional voice disorder = 47 cents, SD = 32 cents) than in control participants (mean = 35 cents, SD = 20 cen differences in the auditory discrimination thresholds between our current data a study likely stemmed from the study design and type of test stimuli. Here, we did the just-noticeable-difference (JND) in pitch, but rather used pure tones.…”

“…This suggests vo order types and/or dysphonic severity may not be linked to the auditory perceptio tion. This finding appeared to agree with observations by Abur et al [4] who fo relationship between the overall severity of dysphonia and auditory discrim…”

“…This suggests voice disorder types and/or dysphonic severity may not be linked to the auditory perception function. This finding appeared to agree with observations by Abur et al [4] who found no relationship between the overall severity of dysphonia and auditory discrimination threshold. It is important to note that their study [4] only included patients with hyperfunction voice disorders, which might have had smaller range of vocal dysfunction than in our study.…”

“…It has been demonstrated that disturbances in auditory perception/discrimination are related to problems within auditory motor reflexes governing effective laryngeal control. These perception problems lead to abnormal motor control patterns as observed in people with hyperfunctional dysphonia [4,5]. The impairment of temporal auditory function in patients with behavioral dysphonia may affect the success of voice therapy, suggesting the need for auditory processing assessment [6].…”

“…Auditory discrimination problems have been shown in people with functional voice disorders. Abur et al [4] showed that patients with hyperfunctional voice disorders had poorer auditory discrimination and more atypical adaptive responses to fundamental frequency (F0) shifts than those without the condition. Stepp et al [5] showed that patients with hyperfunctional voice disorders demonstrated different patterns of adaptive responses in pitch perturbation tasks compared with controls.…”