Auditory Feedback Control of Vocal Pitch in Spasmodic Dysphonia

Objectives/Hypothesis Hearing plays an important role in the maintenance of vocal control in normal individuals. In patients with spasmodic dysphonia (SD), however, the ability to maintain sustained control of phonation is impaired. The origins of SD are unknown, and it is unclear whether auditory feedback-dependent vocal control is compromised in these patients. Study Design Prospective case-control study. Methods We tested 15 SD patients and 11 age-matched controls. Voice recordings were performed while subjects repeated the vowel /e/ and auditory feedback of their vocal sounds was altered in real-time to introduce a pitch-shift (+/- 2 semitones), presented back to subjects using headphones. Recordings were analyzed to determine voice changes following the pitch-shifted feedback. Results were further compared with patient demographics and subjective measures of dysphonia, including the Voice Handicap Index (VHI). Results Despite considerable pitch variability and vocal breaks, SD patients exhibited significantly higher average vocal pitch compensation than control subjects. SD patients also exhibited greater variability than controls. However, there were no significant correlations between vocal compensation and patient demographics, although there was a significant inverse correlation with VHI. Conclusions In this pilot study, patients with SD exhibited increased sensitivity to altered auditory feedback during sustained phonation. These results are consistent with recent theories of SD as a disorder of sensory-motor feedback processing, and suggest possible avenues for future investigation. Level of Evidence 3 Laryngoscope, 2020