Abstract
To determine the cut-off values of different degrees of vocal roughness and breathiness in an analogical visual scale, from a numerical scale. We selected 150 voices from both genders, with quality ranging from neutrality to intense deviations, and predominance of breathiness or roughness. The auditory-perceptual assessment through two scales: 100-mm analogical visual scales and 4-point numerical scale. Intra and interrater reliability of auditory-perceptual ratings was analyzed using the Intraclass Correlation Coefficient. The cut-off values for graduation of roughness and breathiness voices were determinate using the analysis of the Receiver Operating Characteristic (ROC) curve, which is based on the sensitivity, specificity and efficiency. The intra and interrater reliability of auditory-perceptual ratings was excellent on both scales. The cut-off values (mm) in the analogical visual scale, from the numeric scale, indicated a roughness distribution: 0-8.5 absence of the parameter; 8.5- 28.5 mild presence; 28.5- 59.5 moderate and 59.5- 100 intense. For breathiness, the distribution was: 0-8.5 absence of the parameter; 8.5-33.5 for mild presence; 33.5-52.5 moderate and 52.5-100 intense. The cut-off values found for the analogical visual scale conclude that the numerical scale zero, which represents the absence of parameter, corresponds to a small range of scores in the analogical visual scale. Furthermore, the third degree of the numerical scale corresponded to a wide range of the analogical visual scale.
Highlights
The auditory-perceptual analysis is the main vocal assessment procedure used in clinical practice by the speech therapist[1], able to characterize the voice quality, pointing diverted vocal parameter and the degree of vocal deviation, and inferences about their social impact[2,3,4,5]
Of the 150 voices evaluated, 21 were excluded for noncompliance with the sample inclusion criteria, 3 voices excluded for lack of consensus on the predominant feature of vocal deviation, 10 excluded due to difference greater than 10 mm between two or more judges, 4 due to absence of a predominant vocal characteristic, 3 due to tension as the predominant parameter in voice quality and 1 due to instability as the predominant vocal parameter
The intra judge analysis was considered excellent based on Interclass Correlation Coefficient (ICC) results, with p-value between 0.87 and 0.93 in the analogical visual scale and between 0.83 and 0.88 in the numerical scale
Summary
The auditory-perceptual analysis is the main vocal assessment procedure used in clinical practice by the speech therapist[1], able to characterize the voice quality, pointing diverted vocal parameter and the degree of vocal deviation, and inferences about their social impact[2,3,4,5]. To minimize variation from subjectivity is a challenge to improve the auditory perceptual evaluation In this context assessment scales were created and validated[9], among which are numeric and analogical visual scales. ASHA (American Speech-Language-Hearing Association), in text about the CAPE-V, recommends the use of value in millimeters associated to the qualitative description to degree the vocal deviation (e.g.: mild, moderate, severe)(15). Recent studies have been established cutoff values in this context for normal variability of mild, moderate and severe level[10,16,17]. These studies focus on the overall degree of vocal deviation, lacking information regarding the cutoff values for specific parameters
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