MARIA DIETRICH, PH.D, CCC-SLP

- “Exploring the Neural Bases of Primary Muscle Tension Dysphonia: A Case Study Using Functional Magnetic Resonance Imaging.”
- “The frequency of perceived stress, anxiety, and depression in patients with common pathologies affecting voice.”
- “Vocal function in introverts and extraverts during a psychological stress reactivity protocol.”
- “The effects of stress reactivity on extralaryngeal muscle tension in vocally normal participants as a function of personality.”
- “Psychobiological framework of stress and voice'.”
- “Psychobiological stress reactivity and personality in persons with high and low stressor-induced extralaryngeal reactivity.”
- “Preliminary findings on the relation between the personality trait of stress reaction and the central neural control of human vocalization.”


TVF: Tell us about your background.
MD: I am a clinically trained speech-language pathologist with both German and American foundations. After that, I started an academic career, which I am dedicating to voice research.


TVF: Where do you currently teach?
MD: I am an Assistant Professor of Communication Science and Disorders at the University of Missouri in Columbia, Missouri.


TVF: Where did you complete your training?
MD: I have a degree from the Universität zu Köln/Cologne in Germany in Diplom-Heilpädagogik (rehabilitation science) with a major in speech-language pathology and a minor in music therapy, an M.A. degree in speech-language pathology from Kent State University in Ohio, and a Ph.D. degree in communication science and disorders from the University of Pittsburgh in Pennsylvania. I completed my clinical fellowship year at the University of Pittsburgh Voice Center and my postdoc at the University of Kentucky.


TVF: How did you become interested in "voice?"
MD: I had an early fascination with music, voice, and language and also felt comfortable in medical settings. I loved singing in choirs, learning foreign languages, and wondered about my voice whenever I completely lost it when I was sick and otolaryngologists would complete laryngeal mirror exams.


TVF: What prompted your move to the United States?
MD: I moved to the U.S. because of my desire to establish a solid academic foundation in speech-language pathology (SLP). When I started my career in Germany, various paths existed to becoming an SLP. The majority of SLPs had a vocational degree (also known as logopedists) and the minority a University degree. To homogenize German SLP degrees internationally (toward a Bachelor’s degree to enter the field), much attention was paid to ASHA’s accreditation standards for SLPs. Thus, it felt logical to me to go abroad to further my education.


TVF: Please tell us about your research. How has your research evolved over the years? (Please be detailed as possible.)
MD: The goal of my research program is to systematically study personality factors, stress-behavior patterns, and brain function that may promote and maintain primary muscle tension dysphonia (pMTD). Primary MTD is a relatively common voice disorder that has an uncertain cause and questionable long-term response to treatment. The underlying theoretical assumption is that some people are at risk for stress-related voice disorders and that they share a psychoneurobiological profile. An improved understanding of the control of voice production under conditions of stress in people with and without voice disorders is crucial because the role of stress in pMTD remains ill-defined. Since my dissertation, my work toward a psychobiological risk model for pMTD has evolved to have a necessary brain-based, neurobiological component and I have started to include individuals with preclinical voice problems, such as often seen in people who need their voice for their job. The goal of my research is to inform screening, prevention, and treatment methods.


TVF: Your research is very relevant to understanding the pathophysiology of muscle tension dysphonia. How do you hope your research will be applied in the clinical field?
MD: I hope that we can use a combination of neurobiological and psychological profiling to identify those individuals who are laryngeal stress responders. Learning more about a laryngeal stress responder’s profile will help to tailor prevention and treatment strategies to this population.


TVF: Can you help us understand other possibilities of cross disciplinary approaches in voice research? (i.e. engineering, computer sciences, etc.)
MD: Interdisciplinary collaborations with engineering and informatics can be fruitful in many ways. Pattern recognition programs can help make sense of complex or “big data”. For example, many muscles, and more accurately muscle groups, are involved during voice production but it would be ineffective to study each connection in isolation. The bigger picture or Gestalt of pattern and magnitude differences between those with and without voice disorders will be clinically informative. Further, computer simulations can simulate larger clinical datasets or trajectories. Engineers are always helpful to solve applied problems regardless of field.


TVF: Is there a voice research that you are not currently involved in that excites you?
MD: I find research on the genetics of voice disorders and voice pathologies intriguing and cutting-edge and I am excited to read more about it in the future.


TVF: What comes to your mind as one of the pressing issues in contemporary voice disorders?
MD: I feel that we yet have to better understand how voice is planned and produced in the brain and how, for example, individual differences in brain structure and function, life events, and emotional influences may alter brain function, which underlies the occurrence of specific voice disorders or groups of voice disorders. Such knowledge could improve early detection, diagnosis, and treatment effectiveness.


TVF: What is your most memorable voice case?
MD: I remember a case during my clinical fellowship year when I restored a patient’s voice after vocal surgery for Reinke’s edema (fluid filled vocal folds from smoking), which temporarily resulted in a functional aphonia, a complete loss of voice, immediately after surgery. The patient thought that I am a miracle worker. It was an early learning experience for me to see voice therapy through the eyes of a voice patient and to find appropriate language to convey the physiological reason for success to the patient.


TVF: You have many interests besides voice sciences such as painting, playing the piano, etc. What sparks "joy" for you as a person?
MD: Great question. The deepest joys are memorable moments and lasting impressions that move my senses, especially sound or melodies, visual beauty, and deep personal connections. I love the breathtaking national parks and wide skies in Utah, the moments of silence, and the colors of the Rocky Mountains and the Northern Pacific coast.

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