An Updated Theoretical Framework for Vocal Hyperfunction

Purpose The purpose of this viewpoint article is to facilitate research on vocal hyperfunction (VH). VH is implicated in the most commonly occurring types of voice disorders, but there remains a pressing need to increase our understanding of the etiological and pathophysiological mechanisms associat...

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Published inAmerican journal of speech-language pathology Vol. 29; no. 4; pp. 2254 - 2260
Main Authors Hillman, Robert E., Stepp, Cara E., Van Stan, Jarrad H., Zañartu, Matías, Mehta, Daryush D.
Format Journal Article
LanguageEnglish
Published United States American Speech-Language-Hearing Association 01.11.2020
Subjects
Dysphonia
Etiology
Evidence-based medicine
Fatigue (Biology)
Humans
Hypotheses
Longitudinal studies
Pathophysiology
Viewpoint
Vocal fatigue
Vocal folds
Voice
Voice disorders
Voice Disorders - diagnosis
Voice Disorders - etiology
Voice Disorders - therapy
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Summary:Purpose The purpose of this viewpoint article is to facilitate research on vocal hyperfunction (VH). VH is implicated in the most commonly occurring types of voice disorders, but there remains a pressing need to increase our understanding of the etiological and pathophysiological mechanisms associated with VH to improve the prevention, diagnosis, and treatment of VH-related disorders. Method A comprehensive theoretical framework for VH is proposed based on an integration of prevailing clinical views and research evidence. Results The fundamental structure of the current framework is based on a previous (simplified) version that was published over 30 years ago (Hillman et al., 1989). A central premise of the framework is that there are two primary manifestations of VH-phonotraumatic VH and nonphonotraumatic VH-and that multiple factors contribute and interact in different ways to cause and maintain these two types of VH. Key hypotheses are presented about the way different factors may contribute to phonotraumatic VH and nonphonotraumatic VH and how the associated disorders may respond to treatment. Conclusions This updated and expanded framework is meant to help guide future research, particularly the design of longitudinal studies, which can lead to a refinement in knowledge about the etiology and pathophysiology of VH-related disorders. Such new knowledge should lead to further refinements in the framework and serve as a basis for improving the prevention and evidence-based clinical management of VH.
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Disclosure: Robert E. Hillman has a financial interest in InnoVoyce LLC, a company focused on developing and commercializing technologies for the prevention, diagnosis, and treatment of voice-related disorders. Hillman’s interests were reviewed and are managed by Massachusetts General Hospital and Partners HealthCare in accordance with their conflict of interest policies. Cara E. Stepp has received consulting fees from Altec, Inc. and Delsys, Inc., companies focused on developing and commercializing technologies related to human movement. Stepp’s interests were reviewed and are managed by Boston University in accordance with their conflict of interest policies. All other authors have declared that no competing interests existed at the time of publication.
Editor-in-Chief: Julie Barkmeier-Kraemer
Editor: Nancy Pearl Solomon
ISSN:1058-0360
1558-9110
1558-9110
DOI:10.1044/2020_AJSLP-20-00104