# Objective Measures for Clinical Assessment of Voice Disorders

> **NIH NIH R01** · BOSTON UNIVERSITY (CHARLES RIVER CAMPUS) · 2022 · $553,774

## Abstract

Project Summary:
Adductor laryngeal dystonia (AdLD) is a neurological voice disorder characterized by laryngeal spasms. A
secondary symptom is increased vocal effort, likely related to compensatory increases in laryngeal tension.
Voice symptoms significantly impact psychosocial well-being and quality of life. Gold-standard management
requires repeated injections of botulinum toxin (BTX) into laryngeal muscles, each of which provides temporary
reduction in symptoms. New approaches for long-lasting treatment are under development, but can only be
translated to clinical practice if they are evaluated using robust outcomes of vocal function. Unfortunately, there
is a dearth of outcomes that are sufficiently sensitive and specific to the voice symptoms of AdLD. In fact,
clinicians often have difficulty differentiating AdLD from muscle tension dysphonia (MTD), a functional voice
disorder in which there is increased global laryngeal tension without laryngeal spasms, since the two voice
disorders can have shared auditory-perceptual characteristics. To address this gap, objective measures
reflective of both the primary and secondary voice symptoms of AdLD are needed. In our previous grant cycle,
we validated two automated estimates of laryngeal tension (a secondary symptom of AdLD): the kinematic
measure, kinematic stiffness (KS), and the acoustic measure, relative fundamental frequency (RFF). We also
developed a new, automated spectral acoustic measure designed to capture laryngeal spasms in AdLD (a
primary symptom) via detection of pitch breaks (high-passed spectral power of the pitch contour; HSPC).
Combining HSPC and RFF measures, we were able to predict the overall severity of dysphonia in AdLD with
R2=85%. While these results are promising, they must be validated in a larger sample. Thus, we propose an
observational study to construct and validate automated kinematic and acoustic measures of the primary and
secondary symptoms in AdLD. We will assess the physiological and discriminant validity, sensitivity to
change (pre/post treatment), test-retest reliability, and ability of these measures to predict voice severity in
AdLD. In Aim 1 we will compare acoustic estimates of the primary and secondary symptoms of AdLD with
kinematic measures in individuals with AdLD and individuals with MTD. Results will determine the sensitivity
and specificity of these measures and provide the physiological validation of the acoustic measures. In Aim 2
we will assess the sensitivity to change and test-retest reliability of the acoustic and kinematic measures,
validating their use as clinical outcome measures in future assessments of treatment efficacy. Finally, in Aim 3
we will construct and evaluate a statistical acoustic model of overall severity of dysphonia in a large cohort of
speakers with AdLD. Completion of these aims will result in validated, objective, and automated measures of
vocal function that are specific to AdLD, with the potential to be translated imme...

## Key facts

- **NIH application ID:** 10462480
- **Project number:** 5R01DC015570-07
- **Recipient organization:** BOSTON UNIVERSITY (CHARLES RIVER CAMPUS)
- **Principal Investigator:** Cara E. Stepp
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $553,774
- **Award type:** 5
- **Project period:** 2016-07-15 → 2026-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10462480

## Citation

> US National Institutes of Health, RePORTER application 10462480, Objective Measures for Clinical Assessment of Voice Disorders (5R01DC015570-07). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10462480. Licensed CC0.

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