Brain and Voice Signatures in Teachers

Study Overview
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Brief Summary
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Primary muscle tension dysphonia voice disorder with symptoms of vocal strain and vocal fatigue is common and can have a significant negative impact on quality of Life. Yet, primary muscle tension dysphonia's causes are unknown precluding precise diagnostic classification. Stress and personality are thought to play a role and thus, the project aims to determine the practical and clinical effect of stress on the control of voice and speech in the brain. Participants are female early career teachers and student teachers with symptoms of vocal fatigue, as well as control participants without vocal fatigue, who perform speech tasks on two different occasions. Neural (imaging of brain), psychobiological (saliva, personality), and voice and speech (muscle activity of voice muscles on the neck with surface sensors, audio recordings) data will compare reactivity patterns of teachers who are stressresponders with those who are nonresponders as well as control participants. The central hypothesis is that voice box stress responders have heightened emotion-motor activations involving the emotional voice production pathway, which correlate with changes in voice muscle activity in the anterior neck. The results will provide fundamentally missing data in our understanding of the role of stress in vocal complaints and will yield new insights about the neural underpinnings of primary muscle tension dysphonia. The study findings will have a significant impact on how clinicians identify so-called laryngoresponders to help them prevent voice disorders.

Official Title
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Neurobiological and Psychobiological Signatures of Vocal Effort in Early Career Teachers

Conditions
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Voice Disorders, Voice Fatigue

Intervention / Treatment
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* Behavioral: Stress induction


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Teachers (max. 10 years full-time) or student teachers in good health between 21 and 39 years with symptoms of vocal fatigue. Control participants in good health between 21 and 39 years without symptoms of vocal fatigue. Exclusion Criteria: Lefthandedness Smoking (past 5 years) Known changes of the vocal folds (e.g., vocal fold nodules), vocal fold paralysis, surgeries on the larynx or thryoid or current organic or neurological changes of the vocal folds or vocal function per videoendoscopy and -stroboscopy of the larynx History of voice therapy Hoarseness Respiratory illness, allergies (respiratory, silver), reflux or asthma at time of participation Hearing disorder or hearing aids Psychological, neurological or endocrinological disorders Psychotropic or steorid medications Body mass index > 30 Indications against MRI such as metail parts in or on the body (e.g., permanent dental prostheses or braces, screws, prostheses, piercings or large tattoos Nearsightedness > -5 diopters, if only glasses are worn Claustrophobia Pregnancy

Ages Eligible for Study
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Minimum Age: 21 Years
Maximum Age: 39 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Basic Science
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Teachers/student teachers with vocal fatigue<br>Teachers/student teachers with vocal fatigue based on Vocal Fatigue Index (VFI, German). Pre-Screening and Screening. Experiment 1: MRI with MRI-compatible surface electrodes on the neck and audio recordings during MRI with and without stress induction. Prior to MRI, questionnaires on voice, personality, and stress and practice oft the tasks. During experiment, collection of saliva samples (before, during, and after MRI). During MRI, multiple subjective ratings of emotional state by the participants. Experiment 2 (approximately 2 weeks later): Speech tasks with surface electromyographic sensors applied to the neck with concurrent audio recordings. Prior to the experiment questionnaires on voice and practice of tasks. Subjective ratings of vocal and cognitive effort during the experiment by the participants. | Behavioral: Stress induction<br>* Induction of anticipatory stress to compare voice and speech control and production with and without exposure to stress.<br>|
| Active Comparator: Control group<br>Control participants without vocal fatigue based on Vocal Fatigue Index (VFI, German). Same experimental procedures as in arm 1. | Behavioral: Stress induction<br>* Induction of anticipatory stress to compare voice and speech control and production with and without exposure to stress.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Vocal fatigue | Raw scores, Vocal Fatigue Index, VFI Factor 1 | through study completion, an average of 1 month | 
| BOLD MRI area 4p | MRI activation in regions of interest (BOLD area 4p in mean %) as a function of speech tasks with and without stress induction | through study completion, an average of 1 month | 
| Salivary cortisol | Salivary cortisol (nmol/L) to determine stressresponders and nonresponders | through study completion, an average of 1 month | 
| Suprahyoid muscle activity | Suprahyoid muscle activity (RMS) | through study completion, an average of 1 month | 
| Infrahyoid muscle activity | Infrahyoid muscle activity (RMS) | through study completion, an average of 1 month | 
| Personality, Social Potency | Personality trait Social Potency (T-scores, Multidimensional Personality Questionnaire, MPQ) | through study completion, an average of 1 month | 
| Personality, Stress Reaction | Personality trait Stress Reaction (T-scores, Multidimensional Personality Questionnaire, MPQ) | through study completion, an average of 1 month | 
| Personality, social anxiety | Personality trait social anxiety (T-scores, Liebowitz Social Anxiety Scale, LSAS-fear) | through study completion, an average of 1 month | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Vocal fatigue | Raw scores, Vocal Fatigue Index, VFI Factor 2 and 3 | through study completion, an average of 1 month | 
| Voice quality of life | Raw data, Voice Handicap Index, VHI | through study completion, an average of 1 month | 
| Vocal tract discomfort | Raw data, Vocal Tract Discomfort Scale, VTD | through study completion, an average of 1 month | 
| Informal questionnaire on vocal health | Raw data informal questionnaire on vocal health | through study completion, an average of 1 month | 
| BOLD MRI SMA | MRI activation in regions of interest (BOLD area SMA in mean %) as a function of speech tasks with and without stress induction | through study completion, an average of 1 month | 
| BOLD MRI ACC | MRI activation in regions of interest (BOLD area ACC in mean %) as a function of speech tasks with and without stress induction | through study completion, an average of 1 month | 
| BOLD MRI MCC | MRI activation in regions of interest (BOLD area MCC in mean %) as a function of speech tasks with and without stress induction | through study completion, an average of 1 month | 
| BOLD MRI Amygdala | MRI activation in regions of interest (BOLD area Amygdala in mean %) as a function of speech tasks with and without stress induction | through study completion, an average of 1 month | 
| BOLD MRI PAG | MRI activation in regions of interest (BOLD area PAG in mean %) as a function of speech tasks with and without stress induction | through study completion, an average of 1 month | 
| Personality, Wellbeing | Personality trait Wellbeing (T-scores, Multidimensional Personality Questionnaire, MPQ) | through study completion, an average of 1 month | 
| Personality, Social Closeness | Personality trait Social Closeness (T-scores, Multidimensional Personality Questionnaire, MPQ) | through study completion, an average of 1 month | 
| Personality, social anxiety | Personality trait social anxiety (T-scores, Liebowitz Social Anxiety Scale, LSAS-total) | through study completion, an average of 1 month | 
| Personality, self-esteem | Personality self-esteem (raw data, Rosenberg self-esteem scale) | through study completion, an average of 1 month | 
| Behavioral inhibition and exhibition | Behavioral inhibition and exhibition (raw data, BIS/BAS scales, BIS subscale) | through study completion, an average of 1 month | 
| Chronic Stress | Chronic stress (T-scores, Trier Inventory of Chronic Stress, TICS) | through study completion, an average of 1 month | 
| Handedness | Handedness (raw data, Edinburgh Handedness Inventory, EHI) | through study completion, an average of 1 month | 
| State positive and negative affect | State positive and negative affect (raw data, Positive and Negative Affect Schedule, PANAS) | through study completion, an average of 1 month | 
| Voice quality, relative fundamental frequency | Voice quality, relative fundamental frequency (relative fundamental frequency, RFF in semitones [ST]) | through study completion, an average of 1 month | 
| Voice quality, cepstral-spectral analysis | Voice quality, cepstral-spectral analysis (cepstral peak prominence in dB) | through study completion, an average of 1 month | 
| Perceived vocal effort | Perceived vocal effort (raw data, BORG-CR-10) | through study completion, an average of 1 month | 
| Cognitive effort | Cognitive effort (raw data, NASA-TLX) | through study completion, an average of 1 month | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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teachers, speech motor control, voice motor control, voice disorders, vocal fatigue, occupational voice disorders, stress reactivity, vocal control, laryngeal motor cortex