Muscle Tension Patterns Research Articles

Prevalence of Laryngeal Muscle Tension in Patients With Obstructive Sleep Apnea

To determine the prevalence of laryngeal muscle tension in patients with obstructive sleep apnea (OSA). Retrospective case-control. A total of 75 patients were included in this study. These were divided into a study group with a history of OSA (n=45), and a control group with no history of OSA matched according to age and gender (n=30). The risk of OSA was assessed using the STOP-BANG questionnaire. Demographic data included age, gender, body mass index, smoking, history of snoring, history of use of continuous positive airway pressure, and history of reflux disease. Symptoms such as hoarseness, throat clearing/cough, and globus sensation were also noted. The video recordings of the flexible nasopharyngoscopy of both groups were analyzed for the presence or absence of four laryngeal muscle tension patterns (MTPs). Twenty-five patients of the study group (55.6%) had signs of laryngeal muscle tension on laryngeal endoscopy compared to nine in the control patients (30%) (P=0.029). The most common MTP observed in the study group was MTP III (n=19), followed by MTP II (n=17). Laryngeal muscle tension was more prevalent in patients of the intermediate and high-risk categories compared to those of the low-risk category (73.3% and 62.5%vs28.6%, respectively) (P=0.042). Patients with at least one MTP had more dysphonia and throat clearing than patients without any MTP. Patients with a history of OSA have a higher prevalence of laryngeal muscle tension in comparison to subjects with no history of OSA. Moreover, patients at high risk of OSA have a higher prevalence of laryngeal muscle tension than those at low risk of OSA.

Hyperfunctional Laryngeal Behavior: Is It the Cause or Consequence of Vocal Fold Polyps?

To evaluate the relationship between arytenoid adduction asymmetry (AAA) and the demographic and morphological characteristics of true vocal fold (TVF) polyps and establish the cause and effect relationship between AAA and TVF polyps. Videolaryngostroboscopic findings of 163 patients with TVF polyps were retrospectively reviewed and categorized into Group 1 with AAA or Group 2 without AAA. Demographic details, clinicomorphological polyp characteristics, supraglottic phenomena, and AAA attributes were analyzed. Group 1 was younger than Group 2 (fourth vs fifth decade; P = .0066). Polyp characteristics showed no significant intergroup differences. The association between AAA and false vocal fold (FVF) adduction (65.28% vs 47.62% in Group 1 and 2 respectively; P = .0441) was significant. In relation to TVF polyp laterality, contralateral and bilateral AAA and FVF adduction respectively, was significant. AAA is a compensatory laryngeal adaptation akin to a FVF adduction muscle tension pattern. With a concomitant laryngeal pathology and high vocal demand, AAA is a consequence and not the cause for underlying laryngeal pathology which hinders glottic closure.

Presbylarynx, Functional Voice Disorders, Muscle Tension Dysphonia

Presbylarynx refers to age-related structural changes of the vocal folds that include muscle atrophy, reduced neuromuscular control, loss of superficial lamina propria layer, and reduced pliability. The changes result in thin and bowed vocal folds, increased vocal effort requirements, breathy voice, change in habitual pitch, and strain. The primary treatment options are voice therapy focused on strengthening breath support and the intrinsic muscles of the larynx, and optimization of resonance; injection augmentation of the vocal folds; and type I thyroplasty. Functional dysphonia is defined as change in voice quality in the absence of structural or neurological abnormalities of the larynx. Muscle tension dysphonia (MTD) is a subtype of functional voice disorders and involves laryngeal muscle tension imbalance due to excessive or dysregulated activation resulting often in strained or breathy voice. MTD can be divided into primary (psychological etiology or vocal misuse) and secondary (compensatory for organic laryngeal pathology). The mainstay of treatment for MTD is voice therapy, along with medical or surgical treatment of the underlying vocal pathology in secondary MTD. Mutational falsetto, or puberphonia, is a functional voice disorder where a high-pitched, pre-adolescent voice fails to transition to the lower pitch of adulthood. This review contains 5 figures, 7 tables, 4 videos and 10 references Key Words: Presbylarynx, Injection augmentation, Type I thyroplasty, Primary muscle tension dysphonia, Secondary muscle tension dysphonia, Muscle tension patterns, Manual circumlaryngeal therapy, Functional dysphonia, Mutational falsetto

Comparative Study of Increased Supraglottic Activity in Normal Individuals and those with Muscle Tension Dysphonia (MTD)

Excessive or disharmonious activity of internal and external laryngeal muscles causes a type of dysphonia known as muscle tension dysphonia (MTD). MTD is often diagnosed based on laryngoscopic findings and clinical history. Several diagnostic and classification systems have so far been proposed based on increased supraglottic activity to determine MTD. Various studies have shown that increased supraglottic activity may also be observed in those with normal voice. The present study aimed to precisely examine the incidence of abnormal muscle tension pattern (aMTP) in those with normal voice in comparison with those with MTD. The secondary goal of this study was comparative examination of acoustic parameters and maximum phonation time (MPT) in the group with MTD and normal individuals. Participants were 75 people with MTD (41 women and 34 men) and 50 individuals with normal voice and no history of dysphonia (20 women and 30 men). Laryngoscopic evaluation was performed for all participants by considering four types of aMTP. Acoustic analyses, including cepstral peak prominence, jitter, shimmer and NHR, as well as MPT examination were performed. A significant difference between the MTD group and control group was observed in all MTPs except for MTP 2 (lateral-to-medial approximation of the false vocal folds) (P=0.367, χ2(1)=0.81). In other MTPs, a significant difference existed between the control and MTD groups in terms of aMTP incidence (P < 0.05). On the four aMTPs, results revealed that one must exercise caution in diagnosing MTD based on MTP 2 (medial compression of ventricular folds), and this must not be the sole criterion for diagnosis. Moreover, cepstral peak prominence and MPT analyses are of high clinical significance.

Prevalence of MTD among Patients with Functional Dysphagia.

ObjectiveTo assess the prevalence of laryngeal muscle tension patterns among patients with functional dysphagia.Study DesignRetrospective study.SettingThe study took place at a university medical center.Material and MethodsThe medical charts and laryngeal video recordings were reviewed for all patients who presented with dysphagia and who were referred for barium swallow between 2012 and 2017. A total of 170 cases were identified. Only those with normal findings on barium swallow and the absence of vocal fold pathology (exudative lesions, masses or tumors, paresis, and paralysis), referred to as functional dysphagia, were included in this study. Information retrieved included swallowing and phonatory symptoms in addition to patterns of laryngeal muscle tension.ResultsThe mean ± SD age of the total group was 41.90 ± 15.10 years with a male:female ratio of 4:1. Seventy-five percent had evidence of at least 1 type of laryngeal muscle tension pattern. The most common pattern was type III, characterized by supraglottic anteroposterior compression (13 of 20), followed by type II, characterized by medial compression of the false vocal folds (5 of 20); only 1 patient had muscle tension pattern type IV, characterized as sphincter-like closure of supraglottic structures. The most common laryngopharyngeal symptom was throat discomfort when swallowing (35%), followed by throat clearing and choking/coughing when eating and drinking (25%).ConclusionThe high prevalence of laryngeal muscle tension pattern among patients with functional dysphagia supports the notion that laryngeal tension may be one of the underlying causes of dysphagia.

Changes in Abnormal Muscle Tension Pattern after Fiberoptic Injection Laryngoplasty

We performed a retrospective chart review to compare the presence and types of abnormal muscle tension patterns (MTPs) in patients who had been diagnosed with glottal insufficiency before and after fiberoptic injection laryngoplasty. The main cause of glottal insufficiency had been unilateral vocal fold paralysis. Our review included an analysis of the medical records and laryngeal videostroboscopic recordings of 16 patients-9 men and 7 women, aged 25 to 87 years (mean: 59). Stroboscopic frames were analyzed for the presence of one or more types of abnormal MTP. Statistical analysis was performed to determine the significance of the change in scores for type II and type III MTP before injection and 1 month after injection. Before injection laryngoplasty, 15 of the 16 patients exhibited evidence of an abnormal MTP; 10 patients had MTP II only, 2 had MTP III only, and 3 patients had both. The mean percentage of frames showing MTP (i.e., MTP score) in patients with MTP II was 66.2% before the injection and 28.9% 1 month after; the decrease was statistically significant (p = 0.001). For MTP III, the corresponding figures were 71.6 and 37.7% (p = 0.043). We conclude that injection laryngoplasty has a positive effect on reducing muscle tension in patients with glottal insufficiency.

Voice characteristics associated with polycystic ovary syndrome.

To test the assumption that voice is changed in polycystic ovary syndrome (PCOS) and identify changes that occur. Cross-sectional pilot study. Thirty patients with PCOS and a control group of 22 age-matched and body mass index-matched healthy women were included. Demographic data, anthropometric measurement, serum androgens, and Voice Handicap Index-10 were determined. Transnasal fiberoptic laryngoscopy and rigid stroboscopy were performed. Supraglottic hyperfunction was assessed during fiberoptic laryngoscopy. Presence of supraglottic hyperfunction was interpreted as abnormal muscle tension pattern. Glottal closure configuration and vibratory wave characteristics were evaluated via stroboscopy. Acoustic analysis was performed with the Dr. Speech software program version 4 (Tiger DRS Inc., Seattle, WA). Voice complaints and acoustic parameters were similar between groups, whereas serum androgens were significantly higher in patients (P < 0.001). Laryngeal examination detected pathology in 17 (56.7%) patients and two (9.1%) controls (P < 0.001). Fiberoptic examination determined supraglottic hyperfunction in 11 patients but in only two controls (P = 0.023). In stroboscopy, incomplete glottal closure configuration and impaired vocal fold vibration were present in 10 and 11 patients, respectively, whereas only one control had glottal closure abnormality and none of the controls had abnormal vibration (P = 0.028 and P = 0.001, respectively). Abnormal muscle tension patterns and impaired vocal fold vibration are frequent among patients with PCOS; but they are not accompanied by increased vocal symptoms or deteriorated acoustic voice parameters. This may be important for professional voice users or in extensive or extraordinary voice use demands in patients with PCOS. 3b. Laryngoscope, 126:2067-2072, 2016.

English

&nbsp; When the music moves you, you dance. The bodily movement that develops in response to music is what is here considered &ldquo;dance.&rdquo; Philosophers have long understood music as possessing the power to move us. This paper employs Heinrich Wolfflin&rsquo;s theory of &ldquo;sympathetic modeling&rdquo;&mdash;a theory recently validated by neuroscientists&rsquo; discovery of mirror neurons in humans&mdash;and Antonio Damasio&rsquo;s neurobiological model of emotion to establish the mediating links between music and the bodily movements made in response. The first &ldquo;motion&rdquo; elicited by hearing music is, as Wolfflin suggested, an unconscious &ldquo;sympathetic modeling,&rdquo; an internal vocalization of what is heard; this activity involves muscular expansions and contractions. Signals of muscle movement are relayed to the brain by receptor cells imbedded in the muscles. In complex responses, the brain receives patterns of movement from throughout the entire body. When these whole-body kinesthetic sensations are made conscious as perceptions of a unified self, they enter awareness as subjectively felt emotion: the felt response to music. Such patterns of muscular stretching can be abstracted from the sort of external experience that produces emotion in ordinary life experience and reproduced at will. Thus, a dancer, by deliberately reproducing a pattern of muscle stretching, can re-create a chosen specific emotion. This activity constitutes &ldquo;expressing&rdquo; emotion in bodily movement. Performed in response to the emotion elicited by music, it is the expressive gesture of dance. One viewing the dance &ldquo;understands&rdquo; the emotion expressed by, once again, employing sympathetic modeling to reconstruct the internal pattern of movement associated with that emotion. In popular, social, dancing, dancers model one another&rsquo;s movements and, together, model the muscle tension patterns of particular rhythms and melodic lines; this situation is easily accounted for by what is now known about mirror neurons. Neuroscience thus explains what happens when the music moves you. &nbsp; Key words: Emotion, movement, music, dance, aesthetics, neuroscience.

Multi-Modal Assessment and Treatment of Chronic Headache: The First in a Series of Case Studies

The treatment of headache is challenging, and is made more so by the fragmentation of medicine into clinical specialties. Physiologically, migraine headache is a systemic event, affecting multiple neurophysiological systems. Treatment often calls for a multidisciplinary approach. Research supports the efficacy of both general biofeedback and, to a lesser extent, neurofeedback in the treatment of headache, including migraine. Abnormal electrophysiological patterns, detectable with quantitative EEG, are frequently found in patients with migraine, especially after closed head injury. Research has also shown the frequent presence of trigger point activity in several areas of the musculature of the head and neck in headache patients, including those with migraine. Finally, the role of stress has been reported in the onset and exacerbation of headache pain. The authors provide a case study showing the application of quantitative EEG, surface electromyography (SEMG), and psychophysiological stress profiling in the assessment of a 56-year-old female with closed head injury and migraine headache. The treatment included myofascial massage with trigger point release, SEMG training to balance asymmetric muscle tension patterns, and a stress management program, including guided visualization and breath training. This comprehensive intervention produced a significant reduction in headache symptoms and an improvement in work productivity.

Features of Muscle Tension Dysphonia before and after Correction of Unilateral Vocal Cord Paralysis

We performed a retrospective, longitudinal study to compare the prevalence of hyperkinetic laryngeal features before and after successful correction in patients with unilateral vocal cord paralysis (UVCP). Eighty-six patients with UVCP who had a successful surgical correction were enrolled. Preoperative and post-operative videolaryngostroboscopy images were analyzed, and the muscle tension patterns (MTPs) were rated according to the Morrison-Rammage classification. A 4-item glottal closure index was used for each patient on study entry and for 40 normal subjects as the control group. There was no significant difference in MTP prevalence before (57%) and after (55%) surgical correction for UVCP. Although the glottal closure symptoms were tremendously improved through surgical medialization for UVCP, they persisted and were more prevalent than those in normal individuals. Persistence of MTPs after correction of UVCP may be due to intractable vocal habits or psychogenic factors.

Long-Term Outcome of Hyperfunctional Voice Disorders Based on a Multiparameter Approach

The purpose of this study is to determine the long-term voice outcome (6.1 years after a well-defined voice treatment program) of hyperfunctional voice disorders in 27 subjects. All patients showed a muscle tension pattern type I (MTP I). Perceptual ratings, aerodynamic and acoustical analyses, Voice Handicap Index (VHI) value, and a determination of the Dysphonia Severity Index (DSI) were performed. The laryngovideostroboscopic images indicated that 51% of the subjects still show pathological laryngological findings. The negative evolution of the DSI from -1 to -3.2 is in agreement with this finding. Analysis of the components of the DSI shows that the main responsible variable for this negative change is the lowest intensity (I-low) that increased with 8.1 dB, indicating that subjects generally speak too loud, which is a typical problem for vocal hyperfunction. The VHI-score indicates an unimportant psychosocial impact of the voice disorder. The more objective and laryngostroboscopic findings indicate a chronic situation for a substantial part of the subjects and even a worse situation for some of them. Whether the long-term voice outcome results can be changed with the insertion of several follow-up voice rehabilitation sessions over the years remains unanswered and is a subject for further research.

Laryngeal Biomechanics in Middle Eastern Singing

We would like to describe the muscle tension patterns observed in Middle Eastern singing and correlate these findings with demographic data. A total of 42 candidates were included in this study. The medical charts and video records of their fiberoptic nasopharyngeal laryngoscopy were reviewed. Demographic information included age, sex, history of smoking, history of reflux, history of voice overuse/abuse, status in singing (professional vs. amateur), and style of singing (classical vs pop). Each frame was analyzed for each of the four muscle tension patterns (MTPs): MTP I, MTP II, MTP III, and MTP IV. Nonparametric Mann-Whitney U test was conducted. Twenty-six subjects were professional singers and half sang classical singing. The mean MTP total score for all subjects was 35.58 +/- 21.98% (+/- standard deviation). The highest muscle tension score was obtained for type III pattern followed by type II. There were no statistical differences in the mean MTP total, MTP II, and MTP III scores among the professional singers versus the amateurs. Similar results were obtained when MTP scores were compared by style of singing. The vocal technique and status of singing did not seem to affect the muscle tension score.

Muscle tension dysphonia as a sign of underlying glottal insufficiency.

Hyperkinetic vocal function (muscle tension dysphonia) may be an indication of underlying glottal insufficiency. In the face of an organic voice disorder such as presbylaryngis or vocal fold paresis. Hyperkinetic laryngeal behaviors may be used to achieve glottal closure. Such compensatory laryngeal behaviors may mask the correct underlying diagnosis. We sought to evaluate the association between vocal fold bowing due to presbylaryngis and abnormal muscle tension patterns (MTPs). One hundred consecutive volunteers >40 years old were prospectively evaluated. All underwent a comprehensive head and neck examination that included transnasal fiberoptic laryngoscopy with videostroboscopy. Abnormal MTPs were compared in subjects with and without vocal fold bowing. The mean age of the cohort was 61 years. Eighty-four percent (42 of 50) of the male subjects and 60% (30 of 50) of female subjects had evidence of vocal fold bowing. Of the 72 patients with bowing, 94% (68 of 72) had abnormal MTPs. Compared with subjects without vocal fold bowing, persons with bowing were 17 times more likely to exhibit abnormal MTPs (P < 0.001). Abnormal MTPs are common in persons with underlying glottal insufficiency. Patients with vocal fold bowing are 17 times more likely to exhibit abnormal MTPs (95% confidence interval, 4.9 to 59.4). Clinicians should be aware that compensatory hyperkinetic laryngeal behaviors may mask an underlying organic condition.

Laryngeal biomechanics of the singing voice

By transnasal fiberoptic laryngoscopy, patients with functional voice disorders often demonstrate abnormal laryngeal biomechanics, commonly supraglottic contraction. Appropriately, such conditions are sometimes termed muscle tension dysphonias. Singers working at the limits of their voice may also transiently demonstrate comparable tension patterns. However, the biomechanics of normal singing, particularly for different singing styles, have not been previously well characterized. We used transnasal fiberoptic laryngoscopy to study 100 healthy singers to assess patterns of laryngeal tension during normal singing and to determine whether factors such as sex, occupation, and style of singing influence laryngeal muscle tension. Thirty-nine male and 61 female singers were studied; 48 were professional singers, and 52 were amateurs. Examinations of study subjects performing standardized and nonstandardized singing tasks were recorded on a laser disk and subsequently analyzed in a frame-by-frame fashion by a blinded otolaryngologist. Each vocal task was graded for muscle tension by previously established criteria, and objective muscle tension scores were computed. The muscle tension score was expressed as a percentage of frames for each task with one of the laryngeal muscle tension patterns shown. The lowest muscle tension scores were seen in female professional singers, and the highest muscle tension scores were seen in amateur female singers. Male singers (professional and amateur) had intermediate muscle tension scores. Classical singers had lower muscle tension scores than nonclassical singers, with the lowest muscle tension scores being seen in those singing choral music (41%), art song (47%), and opera (57%), and the highest being seen in those singing jazz/pop (65%), musical theater (74%), bluegrass/country and western (86%), and rock/gospel (94%). Analyzed also were the influences of vocal nodules, prior vocal training, number of performance and practice hours per week, warm-up before singing, race, smoking, and alcohol consumption. (Otolaryngol Head Neck Surg 1996;115:527-37.)

Laryngeal biomechanics of the singing voice.

By transnasal fiberoptic laryngoscopy, patients with functional voice often demonstrate abnormal laryngeal biomechanics, commonly supraglottic contraction. Appropriately, such conditions are sometimes termed muscle tension dysphonias. Singers working at the limits of their voice may also transiently demonstrate comparable tension patterns. However, the biomechanics of normal singing, particularly for different singing styles, have not been previously well characterized. We used transnasal fiberoptic laryngoscopy to study 100 healthy singers to assess patterns of laryngeal tension during normal singing and to determine whether factors such as sex, occupation, and style of singing influence laryngeal muscle tension. Thirty-nine male and 61 female singers were studied; 48 were professional singers, and 52 were amateurs. Examinations of study subjects performing standardized and nonstandardized singing tasks were recorded on a laser disk and subsequently analyzed in a frame-by-frame fashion by a blinded otolaryngologist. Each vocal task was graded for muscle tension by previously established criteria, and objective muscle tension scores were computed. The muscle tension score was expressed as a percentage of frames for each task with one of the laryngeal muscle tension patterns shown. The lowest muscle tension scores were seen in female professional singers, and the highest muscle tension scores were seen in amateur female singers. Male singers (professional and amateur) had intermediate muscle tension scores. Classical singers had lower muscle tension scores than nonclassical singers, with the lowest muscle tension scores being seen in those singing choral music (41%), art song (47%), and opera (57%), and the highest being seen in those singing jazz/pop (65%), musical theater (74%), bluegrass/country and western (86%), and rock/gospel (94%). Analyzed also were the influences of vocal nodules, prior vocal training, number of performance and practice hours per week, warm-up before singing, race, smoking, and alcohol consumption.

Muscle tension patterns during auditory attention

Although there is much evidence demonstrating muscle tension changes during mental work, there are few data concerning muscle tension patterns during effortful attention to simple sensory stimuli. In the present study, sensory attention was evoked by a pitch discrimination task at three levels of difficulty, with a digit retention task administered for comparison. Twenty-four females each performed both tasks at all levels of difficulty, while the EKG, and the corrugator supercilii, frontalis, lip, jaw, chin, and forearm area EMG were recorded. As expected, heart rate decreased significantly with increasing difficulty of the pitch task. A pattern of facial EMG responses accompanied the pitch task, which included significant increases in corrugator and frontalis, and decreases in the jaw as a function of difficulty, and time within trials. The tension pattern observed during sensory intake is discussed in terms of its relation to emotional expressions and motor theories of attention.

The EMG gradient as a reflection of metamotivational state.

The significance of motivational statedominance in everyday life and actual motivational state during task performance was investigated in relation to skeletal muscle tension patterns during performance in the continuous preceptual‐motor task paradigm. Subjects were recruited to form seriousminded (telic) and playful (paratelic) extreme groups according to their responses to the Telic Dominance Scale (6 subjects in each group). They all performed a continuous perceptual‐motor task twice in a neutral context (N1, N2), once with threat of aversive shock at poor performance (T), and once with promise of monetary reward for good performance (R); T and R being balanced around N 2. Measures of tonic (slow) EMG activation were derived from the “passive” forearm, and structured (blind) interview assessed motivational state. It was concluded that motivational state, rather than statedominance, was associated with EMG activation. The telic state was significant to high EMG activation for the N I and T treatments in particular.

Active and passive forearm flexor tension patterns in the continuous perceptual-motor task paradigm: The significance of motivation

The psychophysiology of skeletal muscle tension patterns during goal-directed behavior was investigated by using the continuous perceptual-motor task paradigm. Subjects were recruited to form serious-minded and playful extreme groups according to their responses to the Telic Dominance Scale (10 subjects in each group). They all performed a continuous perceptual-motor task 5 times at a ‘slow’ speed followed by a final ‘fast’ task. All performance periods lasted for 150 s. Measures of passive (tonic) and active (phasic) forearm flexor EMG activity were derived. It was concluded that serious-mindedness was significant to a tonic build-up of tension in the passive forearm flexor over the course of task performance. In contrast, the playful state was associated with high phasic response amplitudes in the active forearm flexor contingent upon changing the position of the joy-stick. Training moderated the range of state-specific EMG activation. State measures confirmed that the subjects maintained their state dominance during task performance. Error-scores and scores on felt level of arousal did not discriminate between the groups.

Evaluation of a Pilot Workload Metric for Simulated VTOL Landing Tasks

A methodological approach to measuring workload was investigated for evaluation of new concepts in VTOL aircraft displays. Multivariate discriminant functions were formed from conventional flight performance and/or visual response variables to maximize detection of experimental differences. The flight performance variable discriminant showed maximum differentiation between crosswind conditions. The visual response measure discriminant maximized differences between fixed vs. motion base conditions and experimental displays. Physiological variables were used to attempt to predict the discriminant function values for each subject/condition/trial. The weights of the physiological variables in these equations showed agreement with previous studies. High muscle tension, light but irregular breathing patterns, and higher heart rate with low amplitude all produced higher scores on this scale and thus, represented higher workload levels.

A comparison of muscle tension patterns in psychiatric patients and normals

A comparison of muscle tension patterns in psychiatric patients and normals