Brain Mapping of Voice Control

INCLUSION CRITERIA: The inclusion criteria for normal volunteers are normal vocal function and average health as determined by the staff otolaryngologist. Normal vocal function refers to normal voice quality, a negative history for voice or laryngeal disorders. Persons with significant pulmonary, neurological and psychiatric function will not be recruited. The primary inclusion criteria for the voice disordered groups are a current diagnosis of spasmodic dysphonia (abductor or adductor type), muscular tension dysphonia or voice tremor. These persons will not have pulmonary, neurological or psychiatric disorders or exclusion criteria. INCLUSION CRITERIA - for Patients with Spasmodic Dysphonia: Intermittent strained hoarseness, uncontrolled voice breaks or changes in pitch are present during vowels, liquids (r & l) and semi-vowels (w & y), during speech for adductor SD or prolonged voiceless consonants producing breathy breaks for abductor SD; Less prominent symptoms during whisper, singing or falsetto, Normal voice and vocal fold movement for protective and emotional laryngeal function, such as cough, laugh or cry; A diagnosis of adductor or adductor spasmodic dysphonia based on voice testing and fiberoptic nasolaryngoscopy by a board certified otolaryngologist and Speech-Language Pathologist during the initial interview; Exclusion of other laryngeal pathologies based on a fiberoptic nasolaryngoscopic examination conducted during the initial interview by the staff otolaryngologist. INCLUSION CRITERIA - for Patients with Muscular Tension Dysphonia: Increased phonatory muscle tension in the paralaryngeal and suprahyoid muscles on palpation; A consistent hypertonic laryngeal posture for phonation, such as either an anterior-posterior squeeze (pin-hole posture) or ventricular hyper adduction and an absence of SD or vocal tremor as determined by a Speech-Language Pathologist and the staff otolaryngologist; Exclusion of other laryngeal pathologies based on a fiberoptic nasolaryngoscopic examination conducted during the initial interview by the staff otolaryngologist. INCLUSION CRITERIA - for Patients with Vocal Tremor: Vocal tremor during vocalization that primarily involves laryngeal structures; Exclusion of other laryngeal pathologies based on a fiberoptic nasolaryngoscopic examination conducted during the initial interview by the staff otolaryngologist. EXCLUSION CRITERIA: Any individual with a history of one or more of the following contraindications will be excluded from the study: Airway obstruction, smoking or tobacco use; Pulmonary, or neurological disease; Pregnancy as reported by the volunteer or a positive pregnancy result from a urine sample obtained on the day of testing; Psychiatric disorder, under psychiatric care, or on medication for psychiatric disorders. Examples of psychiatric disorders to be excluded are: somatoform disorders, conversion disorders, major depression, schizophrenia or a bipolar disorder. A history of a previous episode of minor reactive depression would not exclude a person from participation; Speech or hearing problems as determined by medical history and examination by the otolaryngologist. A 30 dB HL hearing screening between 500 and 3000 Hz will be conducted if subjects report difficulty following spoken instructions or significant noise exposure; A reduction in the range of vocal fold movement during non-speech tasks such as whistling suggesting either paralysis or paresis, joint abnormality or neoplasm as determined by videolaryngoscopic examination by the staff otolaryngologist; Complete aphonia, a history of airway obstruction or structural abnormalities affect the larynx such as vocal fold nodules, polyps, carcinoma, cysts, contact ulcers, chronic laryngitis as determined by videolaryngoscopic examination by the staff otolaryngologist; Individuals having any condition that would present unnecessary risk to them, e.g., claustrophobia. Specific contraindications for magnetic resonance imaging include: i) Any implant or surgical clip - implanted neural stimulator, implanted cardiac pacemaker or autodefibrillator, cochlear implant, ocular implant, aneurysm clip, artificial heart valve, insulin pump, orthopedic pins or prosthesis; ii) Any ferromagnetic foreign body - metal shavings, shrapnel, orthodontic braces, certain tattoos or permanent eye liner; and, iii) Any other implanted device or foreign body not listed above that is possibly ferromagnetic.