Repetitive Voice Evaluation in Dysphonic Teachers: Office Versus Home

Abstract

A patient's voice can vary from one moment to another, and these variations cannot be captured by a one-time assessment. Multiple assessments may give a more holistic idea of the severity of the patient's dysphonia and by asking the patient to do the recordings he becomes involved in his therapeutic plan from the beginning. This study aims to evaluate the added value of a repetitive assessment outside the speech therapist's (SLP) clinic, to have a broader vision of the voice disorder and identify parameters that change after working hours to be able to explain this disorder and find solutions for it. Twelve dysphonic Lebanese teachers, aged between 20 and 60 years, recorded their voices once at the SLP's office, and five other times at home every day after working hours. The recordings included a standardized text and a sustained /ɑ/. For perceptive evaluation of voice quality, six SLPs (three experts and three naïve) analyzed the recordings using the GRBAS scale. For self-assessment, patients filled two self-assessment grids at the office: (SSVS: subjective assessment for vocal overwork) and the Lebanese Voice Handicap Index (VHI-10lb) questionnaire. They responded orally to a third scale ranging from 0 to 100 assessing the severity of dysphonia every day after completing the repetitive home recordings. For objective evaluation of the acoustic parameters, PRAAT software was used. Results reveal significant difference between the scores of the voices recorded in the office compared to the home repetitive assessment for the G and R of the perceptual evaluation with P < 0.01, as well as for the Jitter, the fundamental frequency, and the harmonic-to-noise ratio with P < 0.05. The recordings made at home revealed a more severe dysphonia. The self-evaluation scales 1 and 2 (VHI-10Ib, SSVS) did not correlate with the results of the objective and perceptual analysis, whereas the results of the oral self-assessment 3 seem to be in agreement with the results of Jitter (P < 0.05), and Grade of dysphonia (P < 0.05). In teachers, the severity of dysphonia is more pronounced when the voice is recorded after working hours. Daily self-evaluation allows the patient to be more aware of his vocal disorder and voice fluctuations and might improve participation and compliance with therapy. It may also be used to monitor the response to speech therapy.