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Vocal Hyperfunction Clinical Research Center

The Vocal Hyperfunction Clinical Research Center at Massachusetts General Hospital is exploring improved methods and technologies to prevent, diagnose and treat vocal hyperfunction, which is associated with the most frequently occurring types of voice disorders such as vocal cord nodules and muscle tension dysphonia.
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617-643-2466

Overview

Vocal hyperfunction (VH) is one of the most prevalent types of voice disorders and refers to chronic conditions of abuse or misuse of the vocal mechanism (larynx or voice box) due to excessive and/or unbalanced (uncoordinated) muscular forces. These voice disorders include benign vocal fold lesions on vocal cords (commonly called vocal cord nodules) and vocal deterioration in the absence of diagnosable pathology (commonly called muscle tension dysphonia).

About the Center

The Vocal Hyperfunction Clinical Research Center (VHCRC) at Massachusetts General Hospital is a comprehensive, multi-institutional research program that brings together a multidisciplinary team of investigators with various specialties to study hyperfunctional voice disorders. The VHCRC is led by Robert Hillman, PhD, CCC-SLP, research director and co-director of the MGH Voice Center. The central theme of the VHCRC is that clinical management of VH can be significantly improved by attaining a better understanding of the multiple causative factors and associated disordered physiological processes associated with these disorders and then translating this knowledge into new, more effective methods for prevention, diagnosis and treatment.

The center’s scope of research in VH is unprecedented, especially in regards to the integration of many types of data (e.g., behavioral, sensorimotor, environmental, psychological/emotional and biomechanical data) on a large scale, across multiple institutions and areas of expertise.

Scientific Premise

Multiple factors are believed to cause and maintain the disorders linked to VH. The most important include behavioral, sensorimotor, environmental, psychological, emotional and biomechanical mechanisms.

VHCRC’s interdisciplinary research program will focus on understanding the fundamental relationships between these factors and the different manifestations of VH. This will be accomplished in three major research projects led by Robert Hillman, PhD, CCC-SLP, Cara Stepp, PhD, and Matías Zañartu, PhD, and a scientific core led by Daryush Mehta, PhD. They will employ an innovative combination of laboratory studies of sensorimotor and physiological mechanisms; neural network modeling of voice motor control; computational and physical modeling of phonatory mechanisms; and the use of ambulatory biosensors to investigate the potential differential impact on vocal function of daily voice use, psychological stress and environmental noise in patients with VH and well-matched normal controls. Use of ambulatory biofeedback as a treatment strategy will also be assessed.

Goals:

  • To better delineate the etiological and pathophysiological mechanisms that underlie the range of voice disorders associated with VH
  • To develop more specific and accurate classification or phenotyping of VH based on solid scientific evidence of disparate underlying etiological and pathophysiological mechanisms
  • To use the new information about mechanisms of VH to develop and test new clinical methods to improve the prevention, differential diagnosis, and targeted behavioral treatment of hyperfunctional voice disorders

Vocal Hyperfunction Theoretical Framework

Group Members

Administrative Core (Lead: Mass General)

  • Robert Hillman, PhD, CCC-SLP

    617-726-0210

    Director, Vocal Hyperfunction Clinical Research Center

    Co-Director and Research Director, Mass General Voice Center

    Professor of Surgery, Harvard Medical School

    Director of Research Programs, MGH Institute of Health Professions

  • Sarah DeRosa, MS

    Administrator Coordinator for Research and Speech-Language Pathology, Mass General Voice Center

Scientific Core (Lead: Mass General)

  • Daryush Mehta, PhD

    Principal Investigator, Scientific Core, Vocal Hyperfunction Clinical Research Center at Mass General

    Director, Voice Science and Technology Laboratory, Mass General Voice Center

    Assistant Investigator, Mass General; Assistant Professor of Surgery, Harvard Medical School

    Adjunct Assistant Professor, MGH Institute of Health Professions

  • James Burns, MD

    617-726-1444

    Associate Visiting Surgeon, Mass General Voice Center

    Associate Professor in Surgery, Harvard Medical School

    Co-Director, Center for Laryngeal Surgery Fellowship Program

  • Tiffiny A. Hron, MD

    617-726-1444

    Laryngeal Surgeon, Mass General Voice Center

  • Harold Cheyne II, PhD

    Manager of Acoustics Systems Engineering, Cirrus Logic

  • Andrew Ortiz, MS

    Research Engineer, Mass General Voice Center

  • Thomas Quatieri, PhD

    Senior Staff, Bioengineering Systems and Technology Group, MIT Lincoln Laboratory

  • Mark Vangel, PhD

    Statistician, Mass General Hospital

    Assistant Professor in Radiology, Harvard Medical School 

    Biostatistician, General Clinical Research Center, Massachusetts Institute of Technology

  • Jarrad Van Stan, PhD, CCC-SLP

    Research Speech-Language Pathologist, Mass General Voice Center

    Instructor in Surgery, Harvard Medical School

    Adjunct Assistant Professor, MGH Institute of Health Professions

Project 1 (Lead: Mass General)

  • Robert Hillman, PhD, CCC-SLP

    617-726-0210

    Director, Vocal Hyperfunction Clinical Research Center; Principal Investigator, Project 1

    Co-Director and Research Director, Mass General Voice Center

    Professor of Surgery, Harvard Medical School

    Director of Research Programs, MGH Institute of Health Professions

  • Steven Zeitels, MD, FACS

    Director of the Mass General Voice Center

    Eugene B. Casey Professor of Laryngeal Surgery, Harvard Medical School

  • Dimitar Deliyski, PhD

    MSU Foundation Professor and Department Chair, Michigan State University

  • John Guttag, PhD

    Dugald C. Jackson Professor of Computer Science and Electrical Engineering, Massachusetts Institute of Technology

  • Katherine Marks, MS, CCC-SLP

    Research Speech Language Pathologist, Mass General Voice Center

    PhD Student, MGH Institute of Health Professions

  • Daryush Mehta, PhD

    Director, Voice Science and Technology Laboratory, Mass General Voice Center

    Assistant Investigator, Mass General; Assistant Professor of Surgery, Harvard Medical School

    Adjunct Assistant Professor, MGH Institute of Health Professions

  • Nelson Roy, PhD

    Professor of Communication Science and Disorder, University of Utah

  • Joseph Stemple, PhD

    Professor of Rehabilitation Science and Otolaryngology, University of Kentucky

    Co-Director, Laryngeal and Speech Dynamics Laboratory, University of Kentucky

  • Dagmar Sternad, PhD

    Professor of Biology, Electrical and Computer Engineering, and Physics, Northeastern University

  • Laura Toles, MS, CCC-SLP

    Research Speech Language Pathologist, Mass General Voice Center

    PhD Student, MGH Institute of Health Professions

  • Jarrad Van Stan, PhD, CCC-SLP

    Research Speech-Language Pathologist, Mass General Voice Center

    Instructor in Surgery, Harvard Medical School

    Adjunct Assistant Professor, MGH Institute of Health Professions

Project 2 (Lead: Boston University)

  • Cara Stepp, PhD

    Principal Investigator, Project 2, Vocal Hyperfunction Clinical Research Center at Mass General

    Director, Sensorimotor Rehabilitation Engineering Lab, Boston University

    Assistant Professor, Departments of Speech, Language & Hearing Sciences, Otolaryngology-Head & Neck Surgery, and Biomedical Engineering, Boston University

  • Frank Guenther, PhD

    Professor, Department of Speech, Language & Hearing Sciences

    Professor, Department of Biomedical Engineering, Boston University

  • J. Pieter Noordzij, MD

    Professor, Otolaryngology-Head & Neck Surgery, Boston University School of Medicine

  • Joseph Perkell, PhD, DDS

    Senior Research Scientist, Department of Speech, Language & Hearing Sciences, Sargent College, Boston University

Project 3 (Lead: Universidad Tecnica Federico Santa Maria)

  • Matias Zanartu, PhD

    Principal Investigator, Project 3, Vocal Hyperfunction Clinical Research Center at Mass General

    Associate Professor, Department of Electronic Engineering, Universidad Técnica Federico Santa María

  • Byron Erath, PhD

    Assistant Professor, Department of Mechanical and Aeronautical Engineering, Clarkson University

  • Sean Peterson, PhD

    Assistant Professor, Department of Mechanical and Mechatronics Engineering, University of Waterloo

  • Christian Castro, SLP

    Research Staff, Department of Electronic Engineering, Universidad Técnica Federico Santa María

  • Jhosmary Castro

    PhD Student, Department of Electronic Engineering, Universidad Técnica Federico Santa María

  • Juan Pablo Cortes

    PhD Student, Department of Electronic Engineering, Universidad Técnica Federico Santa María

  • Victor Espinoza

    PhD Student, Department of Electronic Engineering, Universidad Técnica Federico Santa María

  • Gabriel Galindo, PhD

    Post-Doctoral Research Associate, Department of Electronic Engineering, Universidad Técnica Federico Santa María

  • Rodrigo Manriquez

    MS Student, Department of Electronic Engineering, Universidad Técnica Federico Santa María

  • Juan Mucarquer

    MS Student, Department of Electronic Engineering, Universidad Técnica Federico Santa María

  • Pavel Prado, PhD

    Post-Doctoral Research Associate, Advanced Center for Electrical and Electronic Engineering, Universidad Técnica Federico Santa María

  • Javier Romero

    MS Student, Department of Electronic Engineering, Universidad Técnica Federico Santa María

  • Juan Yuz, PhD

    Associate Professor, Department of Electronic Engineering, Universidad Técnica Federico Santa María

Research Projects

Vocal Hyperfunction Clinical Research Center (VHCRC) at Massachusetts General Hospital Research Projects

Three research projects focus on investigating mechanisms that are hypothesized to play primary roles in causing and/or maintaining Vocal Hyperfunction (VH).

Project 1: Use of ambulatory biosensors to improve the differential diagnosis and treatment of vocal hyperfunction

Principal investigator: Robert E. Hillman, PhD, CCC-SLP, Mass General

This project uses an innovative combination of ambulatory biosensors, clinical and laboratory studies, and tracking of treatment-related effects to gain new insights into behavioral (daily voice use), environmental (noise levels), emotional (psychological stress/arousal), and physiological (phonatory function) factors related to the etiology and pathophysiology of VH. Researchers will assess the assumed role of emotional stress in eliciting a differential VH response in patients with hyperfunctional voice disorders and normal controls. In a secondary analysis, the team will examine the hypothesized impact of personality and psychological predisposition (trait theory) in modulating the vocal/VH response to emotional stress by having participants complete personality inventories. A major thrust of this project will involve testing hypotheses about the differential impact of VH on the phonatory physiology (biomechanics) associated with phonotraumatic VH (e.g., nodules) and nonphonotraumatic VH (e.g., muscle tension dysphonia). This will also include investigating the potential modulating impact on VH of environmental noise levels (Lombard Effect – increasing vocal SPL) and the presence of nodules (e.g., testing hypotheses related to the need for post-surgical voice therapy to reduce persistent/residual phonotraumatic VH). Special emphasis will be placed on testing biomechanics-based hypotheses related to the role of collision forces in phonotraumatic VH. Use of ambulatory biofeedback as a treatment strategy will also be assessed.

Project 2: Sensorimotor mechanisms of vocal hyperfunction

Principal investigator: Cara E. Stepp, PhD, Boston University

This project uses classic model-driven experimental approaches from speech motor control research to test hypotheses concerning the potential role that disordered sensorimotor mechanisms play in VH. Auditory-motor integration for feedforward and feedback control are examined. These studies include the potential impact that voice therapy might have in reducing such deficits by triggering neuroplastic central nervous system changes. This project will rely on ambulatory measures that are being further refined in Project 1 to assess pre- and post-treatment changes in daily vocal function.

Project 3: Modeling biomechanical and aero-acoustic mechanisms of vocal hyperfunction

Principal investigator: Matías Zañartu, PhD, Universidad Técnica Federico Santa María

This project develops and uses physical and numerical modeling (including subject-specific models) to provide unique insights into the underlying biomechanical, aero-acoustic, and muscle activation mechanisms that contribute to the pathophysiology of VH, providing direct links between model outputs and real clinical data with direct application to the ambulatory assessment of vocal function. This important fundamental work closely links/integrates with Projects 1 and 2 by providing unique insights into these mechanisms that cannot be obtained with current approaches and, in the case of Project 1, extending or improving ambulatory assessment of daily vocal function for clinical evaluation and treatment (biofeedback).

Publications

  1. Erath, B. D., Zañartu, M., & Peterson, S. D. Modeling viscous dissipation during vocal fold contact: the influence of tissue viscosity and thickness with implications for hydration. Biomechanics and Modeling in Mechanobiology. 2017 Jun;16(3):947-960.
  2. Espinoza, V. M., Zañartu, M., Van Stan, J. H., Mehta, D. D., & Hillman, R. E. Glottal aerodynamic measures in adult females with phonotraumatic and non-phonotraumatic vocal hyperfunction. Journal of Speech, Language, and Hearing Research. August 2017, Vol. 60, 2159-2169.
  3. Ghassemi, M., Syed, Z., Mehta, D. D., Van Stan, J. H., Hillman, R. E., & Guttag, J. V. Uncovering voice misuse using symbolic mismatch. JMLR (Journal of Machine Learning Research): Workshop and Conference Proceedings. 2016, 56, 239-252.
  4. Hadwin, P. J., Galindo, G. E., Daun, K. J., Zañartu, M., Erath, B. D., Cataldo, E., et al. Non-stationary Bayesian estimation of parameters from a body cover model of the vocal folds. The Journal of the Acoustical Society of America. 2016, 139 (5), 2683-2696.
  5. Heller Murray, E. S., Lien, Y.-A. S., Van Stan, J. H., Mehta, D. D., Hillman, R. E., Pieter Noordzij, J., et al. Relative fundamental frequency distinguishes between phonotraumatic and non-phonotraumatic vocal hyperfunction. Journal of Speech, Language, and Hearing Research. June 2017, Vol. 60, 1507-1515.
  6. MacPherson, M. K., Abur, D., & Stepp, C. E. Acoustic measures of voice and physiologic measures of autonomic arousal during speech as a function of cognitive load. Journal of Voice. 2017 Jul;31(4):504.e1-504.e9.
  7. McKenna, V. S., Heller Murray, E. S., Lien, Y.-A. S., & Stepp, C. E. The relationship between relative fundamental frequency and a kinematic estimate of laryngeal stiffness in healthy adults. Journal of Speech, Language, and Hearing Research. 2016 Dec 1;59(6):1283-1294.
  8. Mehta, D. D., Van Stan, J. H., Zañartu, M., Ghassemi, M., Guttag, J. V., Espinoza, V. M., et al. Using ambulatory voice monitoring to investigate common voice disorders: Research update. [Original Research]. Frontiers in Bioengineering and Biotechnology. 2015 Oct 16;3:155. 3 (155), 1-14.
  9. Mehta, D. D., Cheyne II, H. A., Wehner, A., Heaton, J. T., & Hillman, R. E. Accuracy of self-reported estimates of daily voice use in adults with normal and disordered voices. American Journal of Speech-Language Pathology. 2016 Nov 1;25(4):634-641.
  10. Mehta, D., Van Stan, J., & Hillman, R. Relationships between vocal function measures derived from an acoustic microphone and a subglottal neck-surface accelerometer. IEEE/ACM Transactions on Audio, Speech, and Language Processing. 2016 Jan 11. 24 (4), 659-668.
  11. Stepp, C. E., Lester-Smith, R. A., Abur, D., Daliri, A., Pieter Noordzij, J., & Lupiani, A. A. Evidence for auditory-motor impairment in individuals with hyperfunctional voice disorders. Journal of Speech, Language, and Hearing Research. 2017 Jun 10;60(6):1545-1550.
  12. Van Stan, J. H., Mehta, D. D., Petit, R. J., Sternad, D., Muise, J., Burns, J. A., et al. Integration of motor learning principles into real-time ambulatory voice biofeedback and example implementation via a clinical case study with vocal fold nodules. American Journal of Speech-Language Pathology. 2017 Feb 1;26(1):1-10.
  13. Van Stan, J. H., Mehta, D. D., Sternad, D., Petit, R., & Hillman, R. E. Ambulatory voice biofeedback: Relative frequency and summary feedback effects on performance and retention of reduced vocal intensity in the daily lives of participants with normal voices. Journal of Speech, Language, and Hearing Research. April 2017, Vol. 60, 853-864. 
  14. Van Stan, J. H., Mehta, D. D., Zeitels, S. M., Burns, J. A., Barbu, A. M., & Hillman, R. E. Average ambulatory measures of sound pressure level, fundamental frequency, and vocal dose do not differ between adult females with phonotraumatic lesions and matched control subjects. Annals of Otology, Rhinology, and Laryngology. 2015 Nov;124(11):864-74.

Contact

Contact Us

Vocal Hyperfunction Clinical Research Center

One Bowdoin Square, 11th FloorMGH Voice Center Boston, MA 02114
  • Near Public Transit

 

Email Us

617-643-2466

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