# Identifying physical and behavioral factors and mechanisms to improve detection and phenotyping of vocal hyperfunction

> **NIH NIH P50** · MASSACHUSETTS GENERAL HOSPITAL · 2024 · $769,363

## Abstract

Project Summary/Abstract
Voice disorders have been estimated to affect approximately 30% of the adult population in the United States at
some point in their lives with the most prevalent being associated with vocal hyperfunction. Phonotraumatic vocal
hyperfunction (PVH) is associated with the formation of benign vocal fold lesions (e.g., nodules and polyps).
Vocal hyperfunction is also associated with dysphonia that occurs in the absence of concurrent vocal fold trauma
or other structural/neurological abnormalities (e.g., muscle tension dysphonia), which is referred to as non-
phonotraumatic vocal hyperfunction (NPVH). Unfortunately, the prevention, diagnosis, and treatment of these
hyperfunctional voice disorders continue to be hampered by limited knowledge of the etiological and
pathophysiological mechanisms that underlie specific voice disorders within the broad range of those associated
with vocal hyperfunction.
This project continues to elucidate multiple factors/mechanisms that are assumed to play important roles in
causing and maintaining hyperfunctional voice disorders using a combination of data from ambulatory voice
monitoring and other important sources: reflux status, personality, vocal reactivity to environmental sound levels,
responses to voice therapy and ambulatory biofeedback, assessment of auditory-motor deficits, and model-
generated estimates of phonatory physiological parameters that are difficult/impossible to measure clinically.
Research during this second grant cycle will focus on the interrelated goals of further improving the detection of
PVH and NPVH and identifying clinically meaningful subgroups (phenotypes) within these two broad categories.
Detection will be improved by developing two new ambulatory measures, energy dissipation dose (EDD), which
is expected to be more sensitive to mild (early-stage) phonotrauma, and a time series voicing-resting ratio (VRR)
that will provide objective insight into how the relationship between vocal load and recovery is associated with
phonotrauma and vocal fatigue. A combination of advanced statistical and machine learning approaches will be
applied to our growing comprehensive/multidimensional voice database to optimize the discovery of PVH and
NPVH subgroups based on differences in objective measures of daily (ambulatory) vocal behavior and phonatory
pathophysiology. The subgroups will be further differentiated by additional measures that reflect deeper insights
into pathophysiological mechanisms (e.g., intrinsic laryngeal muscle activation levels, vocal fold collision
pressure, etc.) and potential predisposing factors (e.g., personality, reflux, etc.).
Achieving the goals of this research program will lead to improved prevention, differential diagnosis, and more
focused and efficient treatment of these highly prevalent voice disorders.

## Key facts

- **NIH application ID:** 10829475
- **Project number:** 5P50DC015446-07
- **Recipient organization:** MASSACHUSETTS GENERAL HOSPITAL
- **Principal Investigator:** Robert E Hillman
- **Activity code:** P50 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $769,363
- **Award type:** 5
- **Project period:** 2017-04-15 → 2028-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10829475

## Citation

> US National Institutes of Health, RePORTER application 10829475, Identifying physical and behavioral factors and mechanisms to improve detection and phenotyping of vocal hyperfunction (5P50DC015446-07). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10829475. Licensed CC0.

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