Top-Down Modulation of Auditory-Motor Integration in Individuals with Primary Muscle Tension Dysphonia: The Role of Auditory Working Memory.

OBJECTIVES

This study investigated whether auditory working memory (AWM) training can modulate auditory-motor integration and reduce maladaptive vocal compensations in individuals with primary muscle tension dysphonia (pMTD), a voice disorder characterized by hyperfunctional laryngeal behavior in the absence of organic pathology.

METHODS

Twenty individuals with pMTD were randomly assigned to either an intervention group receiving 12 days of AWM training using a frequency pattern recognition paradigm or a control group receiving vocal hygiene education only. Vocal compensatory responses to pitch-shift stimuli (PSS) (±100 cents) were measured pre- and post-intervention using a reflexive altered auditory feedback paradigm.

RESULTS

The intervention group showed significant improvements in AWM capacity (paired t test: t(9) = 18.04, P < 0.001) and reduced vocal compensatory responses to both upward and downward pitch perturbations (PSS-Up: t(9) = -3.06, P = 0.014; PSS-Down: t(9) = 3.63, P = 0.006), with stronger effects for downward shifts. No significant changes were observed in the control group (PSS-Up: t(9) = 1.30, P = 0.227; PSS-Down: t(9) = -1.68, P = 0.128). Analysis of Covariance (ANCOVA) confirmed significant between-group differences in post-intervention compensation magnitudes (PSS-Up: F(2,17) = 4.86, P = 0.021; PSS-Down: F(2,17) = 7.14, P = 0.006).

CONCLUSIONS

AWM training enhances auditory-motor integration in pMTD by reducing maladaptive vocal compensation, supporting a top-down model of vocal motor control. These findings suggest that cognitive-based interventions targeting AWM could complement traditional voice therapies by targeting central mechanisms of sensorimotor integration, offering a novel approach to improving treatment outcomes in pMTD.