Auditory-perceptual Analysis Research Articles

Speech characteristics in individuals with myasthenia gravis: a case control study

Introduction Myasthenia Gravis (MG) is an autoimmune disease. The characteristic symptoms of the disease are muscle weakness and fatigue. These symptoms affect de oral muscles causing dysarthria, affecting about 60% of patients with disease progression. Purpose Describe the speech pattern of patients with MG and comparing with healthy controls (HC). Material and methods Case–control study. Participants were divided in MG group (MGG) with 38 patients MG diagnosed and HC with 18 individuals matched for age and sex. MGG was evaluated with clinical and motor scales and answered self-perceived questionnaires. Speech assessment of both groups included: recording of speech tasks, acoustic and auditory-perceptual analysis. Results In the MGG, 68.24% of the patients were female, with average age of 50.21 years old (±16.47), 14.18 years (±9.52) of disease duration and a motor scale of 11.19 points (±8.79). The auditory-perceptual analysis verified that 47.36% (n = 18) participants in MGG presented mild dysarthria, 10.52% (n = 4) moderate dysarthria, with a high percentage of alterations in phonation (95.2%) and breathing (52.63%). The acoustic analysis verified a change in phonation, with significantly higher shimmer values in the MGG compared to the HC and articulation with a significant difference between the groups for the first formant of the /iu/ (p = <.001). No correlation was found between the diagnosis of speech disorder and the dysarthria self-perception questionnaire Conclusion We found dysarthria mild in MG patients with changes in the motor bases phonation and breathing, with no correlation with severity and disease duration.

Comprehensive Evaluation of Voice-Specific Outcomes in Patients With Essential Tremor Before and After Deep Brain Stimulation

Deep brain stimulation (DBS) is a treatment for medically refractory essential tremor (ET), but there is a paucity of literature examining the effects of DBS on voice in patients with ET pre-DBS and post-DBS. This study aimed to report a comprehensive evaluation of voice in patients with ET pre-DBS and 6-months post-DBS. Case series. Five patients receiving DBS for ET underwent voice evaluations pre-DBS and 6-months post-DBS. One patient had concurrent ET of the vocal tract (ETVT). The evaluation included patient-reported, perceptual, acoustic, and phonatory aerodynamic analyses of voice. Voice Handicap Index-10, Grade, Roughness, Breathiness, Asthenia, Strain Scale, perturbation measures, cepstral spectral index of dysphonia, cepstral peak prominence, and mean phonatory airflow measures were also among the data collected. Patients with ET presented with minimal changes in perceptual, acoustic, and phonatory aerodynamic parameters. Perceived vocal roughness significantly increased 6-months post-DBS (P = 0.047). The patient with ETVT presented with clinically significant improvement in almost all collected voice parameters 6-months post-DBS. This is the first study to provide data encompassing auditory perceptual voice analysis, voice-specific patient-reported quality of life measures, acoustic, and phonatory aerodynamic outcomes in patients pre-DBS and 6-months post-DBS for ET. The results of our preliminary study have implications for the use of a comprehensive voice assessment to identify and measure change in voice outcomes in patients with ET and ETVT pre- and postsurgery.

Validation of the Brazilian Portuguese CAPE-V Instrument—Br CAPE-V for Auditory-Perceptual Analysis

The Consensus Auditory Perceptual Evaluation of Voice (CAPE-V) scale is a modern, clinical-scientific approach to voice analysis. It has been translated and culturally adapted to Brazilian Portuguese, but it still lacks validation. To validate the Brazilian Portuguese version of the CAPE-V scale using the previously translated and culturally adapted version. Forty voice samples were selected (30 dysphonic, 10 nondysphonic), and the degree of vocal deviation was evaluated by a committee of three voice specialists. Nine voice specialists judged the 40 voice samples plus 20% repetition (total of 48 samples) using the CAPE-V. To ensure construct validity of the CAPE-V, its analysis was compared to the Grade-Roughness-Breathiness-Asthenia-Strain (GRBAS) scale that was performed 48-72 hours later. Finally, the intra- and inter-rater reliability values were verified and the correlation between the nine judges and the previously defined evaluation was analyzed. The Brazilian CAPE-V presented significant intra (0.860-0.997) and inter-rater reliability values (0.707-0.964) for the overall degree and strong correlation with GRBAS (above 0.828). Deviant voice quality had greater consensus among raters than normal voices. A strong correlation was observed between the analysis of the nine raters and that of the committee. CAPE-V is an important diagnostic instrument that contributes to the standardization of vocal quality evaluation in several languages, including Brazilian Portuguese. Thus, its usefulness is neither related to a single language nor to a single set of raters.

Pre-operative subjective and objective voice assessment in patients with benign thyroid disorders

Background: Changes in voice quality are common in patients with different thyroid disorders. Objectives: This work aims to identify subjective and objective voice changes in candidates for surgery for nonmalignant thyroid diseases to highlight its role in preoperative voice assessment and early detection of laryngeal disorder in those patients for further management. Methods: The patients’ group included 60 consecutive patients with benign thyroid disease; their ages ranged between 19 and 65 years. Age and gender-matched control group included 30 healthy normal subjects. Both groups were subjected to clinical examination, modified GRBAS scale, Voice handicapped index, acoustic analysis, and flexible nasolaryngoscopy. Results: Patients with thyroid disorders have significant dysphonia of mild to a moderate degree, as detected by APA in 38 % of patients. Acoustic analysis revealed altered jitter in 41% of patients and altered shimmer in 33%. Patients with abnormal thyroid hormone have more significant voice changes than patients with the euthyroid state. Conclusion: The Auditory perceptual voice analysis and VHI revealed significant changes in overall voice quality and grade of dysphonia in patients with thyroid disease in a way that can be judged as a sensitive and reliable assessment tool being as acoustic analysis. Patients with abnormal thyroid hormone have a more chance to have voice disorders than patients with the euthyroid state. APA of voice must be a routine assessment for patients with benign thyroid disease, and patients with dysphonia have to be referred for voice specialists for further assessment.

Pharyngeal bulb prosthesis and speech outcome in patients with cleft palate

IntroductionIndividuals with cleft palate can present with velopharyngeal dysfunction after primary palatoplasty and require a secondary treatment due to insufficiency. In these cases, the pharyngeal bulb prosthesis can be used temporarily while awaiting secondary surgery. ObjectiveThis study aimed to investigate the outcome of treatment of hypernasality with pharyngeal bulb prosthesis in patients with history of cleft palate presenting with velopharyngeal insufficiency after primary palatal surgery. We hypothesized that the use of the pharyngeal bulb prosthesis is an effective approach to eliminate hypernasality related to velopharyngeal insufficiency in patients with cleft palate. MethodsThirty speakers of Brazilian Portuguese (15 males and 15 females) with operated cleft palate, ages ranging from 6 to 14 years (mean: 9 years; SD = 1.87 years), participated in the study. All patients were fitted with a pharyngeal bulb prosthesis to manage velopharyngeal insufficiency while they were awaiting corrective surgery to be scheduled. Auditory-perceptual analysis of speech recorded in the conditions with and without pharyngeal bulb prosthesis were obtained from three listeners who rated the presence or absence of hypernasality for this study. ResultsSeventy percent of the patients eliminated hypernasality while employing the pharyngeal bulb prosthesis, while 30% still presented with hypernasality. The comparison was statistically significant (p < 0.001). ConclusionThe use of the pharyngeal bulb prosthesis is an effective approach to eliminate hypernasality related to velopharyngeal insufficiency.

Voiced High-Frequency Oscillation or Lax Vox Technique? Immediate Effects in Dysphonic Individuals

To analyze the immediate effects of voiced high-frequency oscillation (VHFO) and Lax Vox technique on vocal quality and self-reported intensity of vocal and laryngeal symptoms in individuals with behavioral dysphonia. This experimental, prospective, randomized cross-over study, investigated thirty adults (15 women and 15 men) with behavioral dysphonia (vocal complaints, altered voice on auditory-perceptual evaluation, vocal nodules or mucosal thickening, and incomplete glottic closure). The outcome variables analyzed were auditory-perceptual analysis, acoustic analysis (voice quality characteristics), and self-reported intensities of vocal and laryngeal symptoms. Each participant performed two exercises-VHFO and Lax Vox technique-in a random sequence for 3 minutes. A 7-day washout period was provided between the exercises. The data were analyzed using the paired t-test and Wilcoxon test (P < 0.05). After VHFO, no significant difference was observed on auditory-perceptual evaluation in all participants, whereas the Lax Vox technique worsened breathiness among women (P=0.027). VHFO significantly increased the fundamental frequency (P=0.014) and decreased the noise harmonic ratios for women (P=0.026). Among men, there was a decrease in shimmer parameter (P=0.035). Moreover, symptoms such as "lump in the throat" (P=0.005), "voice loss" (P=0.017), and "high-pitched voice" (P=0.023) decreased in women after VHFO, whereas in men, "itchiness" and "hoarseness" (P < 0.001) decreased after VHFO. The Lax Vox technique decreased "hoarseness" (P=0.003) in women, without any effect in men. The VHFO exercise provided more positive immediate effects results than the Lax Vox technique regarding vocal quality and self-reported symptom intensity in participants with behavioral dysphonia.

Assessment of dysphonia: cepstral analysis versus conventional acoustic analysis

Objective In this study, we aimed to determine the extent to which smoothed cepstral peak prominence (CPPS) can replace or complement the conventional acoustic measures of jitter, shimmer, and harmonic-to-noise ratio in the assessment of various types of dysphonia. Methodology A total of 60 males and 80 females were divided into two groups: dysphonic group and control group (30 males and 40 females in each group). The voice samples in the form of sustained vowel /a/ phonation and continuous speech were recorded and assessed using auditory perceptual analysis, acoustic analysis, and cepstral analysis. Results Jitter was found to have the best predictive ability during sustained phonation, whereas CPPS was found to have the best predictive ability during continuous speech. Conclusion Cepstral analysis is as reliable as the conventional acoustic analysis in the diagnosis of dysphonia and to detect its severity. However, CPPS cannot replace conventional acoustic measures.

Swallowing, voice and quality of life of patients submitted to extended supratracheal laryngectomy.

ABSTRACTObjective To describe functional and quality of life results after extended supratracheal laryngectomy.Methods In the period from September 2009 to January 2018, 11 male subjects were submitted to extended supratracheal laryngectomy. Swallowing abilities were assessed through videofluoroscopy and the clinical scale Functional Communication Measures of Swallowing. The voices were classified by means of the perceptual-auditory analysis Consensus Auditory-Perceptual Evaluation of Voice. All subjects completed a self-assessment questionnaire for voice and swallowing.Results Aspiration was found in four patients and all presented stasis in different structures. All subjects in this study were exclusively orally fed and hydrated. In the evaluation of quality of life in swallowing, patients had mean >80 in all areas (83.47 mean of scores). The general degree and the presence of roughness were the highest means present in Consensus Auditory-Perceptual Evaluation of Voice (37.81 and 49.36, respectively). The mean of 33.36 (±22.56) had little impact on quality of life under the perspective of vocal aspects.Conclusion After supratracheal laryngectomy, swallowing was sufficiently restored and the quality of life was satisfactory. The voice presents severely impaired quality and preserved oral communication, with low impact on the activities of daily living. All individuals who maintained two cricoarytenoid units presented better functional results in swallowing and voice.

Associations Between Teachers’ Autonomic Dysfunction and Voice Complaints

This investigation aimed to verify if there were any differences in autonomic nervous system function and voice parameters of teachers with and without voice complaints. Cross-sectional study. The Questionnaire of Autonomic Dysfunction was answered by 24 teachers, 6 males, and 18 females, whose heart rate variability was also assessed. Aerodynamic assessment of voice, acoustic and auditory-perceptual analysis of voice were done. Participants were divided into two groups: without voice complaints (WVCG; n=11) and with voice complaints (VCG; n=13) based on the completion of the Sociodemographic and Clinical Questionnaire. For auditory-perceptual analysis, VCG showed significantly higher values on GRBASH subscales Grade (P < 0.001) and Roughness (P=0.011). Regarding the heart rate variability, it was found that in the VCG, the square root of the mean squared difference of successive RR intervals (RMSSD) and the percentage of adjacent NN intervals differing by more than 50 milliseconds (pNN50) were significantly lower than in the WVCG (P=0.023 and P=0.032, respectively). The VCG presented a higher occurrence of neurovegetative symptoms directly related to voice, namely in fluctuating nose obstruction (P=0.011), neck pain (while or after speaking) (P=0.017) and in fatigability when speaking (P=0.004). Concerning the aerodynamic assessment of voice, acoustic analysis of voice and neurovegetative symptoms not directly related to voice, no statistically significant differences between groups were found. Findings indicated significantly lower values in RMSSD and pNN50 of teachers VCG when compared with teachers WVCG and that the teachers VCG presented a higher occurrence of neurovegetative symptoms directly related to voice than the ones WVCG.

Associations between Teachers’ Posture, Muscle Tension and Voice Complaints

The interaction between muscle tension, posture, and vocal use is very complex as clinical research suggests that abnormal laryngeal posture can be associated with muscle adaptive changes, although specific evidence concerning body posture and voice disorders has been lacking. Thus, the aim of this study was to verify if there were differences in posture, muscle tension and voice between teachers with and without voice complaints. Cross-sectional study. Twenty-four teachers, 6 males and 18 females, were submitted to photogrammetry, muscle tension assessed trough palpation and algometry assessment. Aerodynamic assessment of voice, acoustic and auditory-perceptual analysis of voice were done. Participants were divided into without voice complaints group (WVCG; n=11) and voice complaints group (VCG; n=13) based on Sociodemographic and Clinical Questionnaire completion. For auditory-perceptual analysis, VCG showed a significant higher values on GRBASH subscales Grade (p < 0.001) and Roughness (p=0.011). The VCG showed statistically significant higher values on muscle tension of suprahyoids (p=0.001), thyrohyoids (P=0009) and cricothyroids muscles (p=0.040) and statistically significant lower values on algometry of the cricothyroid (p=0.023 left and p=0.026 right), suprahyoids (p=0.017 left & p=0.018 right), thyrohyoids (p=0.006 left and p=0.007 right) and pharyngolaryngeal (p=0.016 left and p=0.021 right) muscles of both sides. Concerning the aerodynamic assessment of voice and acoustic analysis of voice, no statistically significant differences between the groups were found. Findings indicated statistically significant differences in muscle tension in laryngeal intrinsic muscles and auditory-perceptual analysis between teachers with and without voice complaints.

Cut-off point for high dysphonia risk in children based on the Child Dysphonia Risk Screening Protocol: preliminary findings

OBJECTIVES:The objective of the study was to establish a cut-off point for high dysphonia risk in children using the Child Dysphonia Risk Screening Protocol (DRSP-C).METHODS:Through a preliminary study, voice recordings of 59 children (4-12 years of age) were collected during an auditory-perceptual analysis using the Consensus Auditory-Perceptual Evaluation of Voice protocol. Thirty of the patients had voice disorders (patient group), and 29 did not (control group). A risk score for dysphonia was then calculated, and data were compared between groups. The relationship between overall degrees of deviation and questionnaire scores was analysed. The questionnaire’s validity was verified from the area under the Receiver Operating Characteristic (ROC) curve, and cut-off points were obtained based on diagnostic criteria for screening procedures.RESULTS:The DRSP-C score was found to be higher for the patient group, as was the partial score for vocal behaviour. No correlation was found between overall degrees of dysphonia and questionnaire scores. The area under the ROC curve was measured as 0.678, denoting limited diagnostic capacity. The cut-off point was set at 16.50. Thus, above this value, dysphonia risk is higher.CONCLUSION:A cut-off point for high dysphonia risk was calculated. The DRSP-C proved to be a promising tool for children’s clinical vocal and health promotion and should be used in conjunction with General Dysphonia Risk Screening.

Upper high notes: auditory-perceptual analysis of voice and self-reporting among professional sopranos.

To describe the emission of upper high notes by professional sopranos by means of the auditory-perceptual evaluation of the singers' voices and self-reports. Five professional sopranos performed an excerpt from a Bellini opera which involved the emission of an upper high note. The auditory-perceptual evaluation was carried out by three speech-language therapists and three singing teachers, who considered brightness, loudness, metal quality, vibrato, breathiness, and resonance on a visual-analytical scale, based on each singer's emission of high notes. After the recording, the singers were asked to answer a proprioceptive questionnaire on the physical sensations that they had as they emitted upper high notes. An inferential analysis of the data from the auditory-perceptual evaluation was conducted, and the singers' self-reports were summarized and then orthographically transcribed. In the auditory-perceptual analysis, the emission of upper high notes was characterized according to the presence of brightness, loudness, metal quality, vibrato, and anterior resonance, as perceived by speech-language therapists and singing teachers. In the proprioceptive report, all singers reported laryngeal elevation and a need to use respiratory support in order to emit upper high notes. Upper high notes are characterized by a bright vocal emission, enhanced loudness, with a metallic quality and vibrato, little or no breathiness, accompanied by a sensation of laryngeal elevation and a need for respiratory support.

Laryngostroboscopy and voice evaluation in adult patients with Parkinson s disease

Introduction: Most patients with Parkinson’s disease (PD) present tongue, larynx and pharynx disorders, affecting voice and speech. Objective: To evaluate the laryngeal manifestations of PD. Methods: Evaluation of 18 PD patients conducted between January 2011 and December 2012. Patients were evaluated through videolaryngostroboscopy, auditory perceptual analysis of the voice using the GIRBAS scale, acoustic voice analysis, and application of the Vocal Handicap Index (VHI) questionnaire. Results: Dysphonia and vocal fatigue were referred by 72.22 and 33.3% of the patients, respectively, whereas changes during laryngoscopy were verified in 94.44%. The medians of the acoustic voice analysis and the VHI self-assessment questionnaire were unchanged. The median of the VHI emotional domain was higher among patients who presented open phase closure, with statistically significant difference (p=0.029). Conclusion: Patients with PD present laryngeal and voice changes.

Effect of the Finnish Tube on the Voice of a Deaf Musician: A Case Report

To verify the auditory-perceptual and acoustic effects of the semioccluded vocal tract exercise with Finnish tube on the vocal quality of a deaf musician. A seven-day protocol with Finnish tube was performed with guidance for its home replication twice a day. A 46-years-old man with profound bilateral sensorineural hearing loss, musician and composer participated. Before and after the application of the protocol had undergone tonal audiometry, nasofibrolaryngoscopy, acoustic analysis with Praat and auditory-perceptual evaluation of the voice with Voice Profile Analysis Scheme for Brazilian Portuguese. The postintervention auditory-perceptual analysis identified reduction of the deviation in lip spreading, extensive labial range, raised tongue body, pharyngeal expansion, nasal resonance, larynx height, larynx and vocal tract tension and irregularity, pitch, speech rate, and a better respiratory support. The maximum phonation time reduced, probably because of elimination of the abrupt vocal attack and tension, articulatory deviations, improvement in voicing and the absence of the use of expiratory reserve air. The fundamental frequency became lower, and the first, second, third, and fourth formants became higher. The jitter increased, and the shimmer reduced. The use of the Finnish tube might have facilitated the voicing sensations in the deaf musician, by enhancing the tactile-kinesthetic perception of the vocal tract and brought a greater source-filter interaction.

Laryngeal Microsurgery for the Treatment of Vocal Nodules and Cysts in Dysphonic Children

Introduction: Vocal nodules and cysts are frequent causes of infantile dysphonia. Vocal therapy is the first treatment. Microsurgery has restricted indications, especially for nodules. Objective: To describe our experience with microsurgery for nodules and cysts in children. Methods: Dysphonic children (aged 4–18 years) with the diagnosis of nodules and vocal cysts were initially selected. Of these children, only those were included who had undergone microsurgery. For nodules and cysts, the microsurgery was indicated in cases of failure of vocal therapy and in cases of voice worsening or doubts about the diagnosis. All children were submitted to auditory perceptual vocal analysis and videolaryngostroboscopy (before and after surgery, after 6 months). Surgical outcomes were: total improvement (disappearance of vocal symptoms and of the laryngeal lesions); partial improvement (partial improvement of symptoms and/or maintenance of lesions); no improvement (maintenance or worsening of the symptoms and/or persistence of the lesions). ­Results: There were 78 children with vocal nodules and 27 children with vocal cysts. Surgery was indicated for 12 children with vocal nodules (15.4%) and 12 children with cysts (44.4%). Total improvement registered for nodules and cysts was 75 and 83.4%, respectively. Partial improvement for both lesions was 25 and 16.6%, respectively. Conclusion: The best outcome for laryngeal microsurgery in dysphonic children was for vocal cysts. So, we encourage laryngologists for this conduct in vocal cysts. The success of microsurgery for vocal nodules was lower, and in these cases voice therapy seems to be the best treatment.

Voice Function in Gender-Diverse People Assigned Female at Birth: Results From a Participant-Centered Mixed-Methods Study and Implications for Clinical Practice

Purpose The purpose of this study was to investigate whether there were indications of restrictions to voice function in our group of gender-diverse people assigned female at birth (GD peopleAFAB) and whether the participants would benefit from professional voice support. Method We conducted a descriptive, cross-sectional, mixed-methods study combining qualitative content analyses of semistructured interviews, phoniatric examinations, and acoustical voice analyses. Fourteen German-speaking GD peopleAFAB participated. The data were examined for indications of restrictions to voice function according to the results of participant self-evaluation, auditory-perceptual analyses, laryngostroboscopic examinations, and acoustical measurements. Results All participants presented with indications of restrictions to voice function, with vocal power, voice quality, singing voice, laryngeal function, pitch range/variability, and vocal control having found to be most frequently affected (in over 60% of participants). Sixty-four percent of participants expressed an interest in professional voice support, with clinicians and researchers recommending professional voice support for 67% and 71%, respectively. Conclusions GD peopleAFAB may experience restrictions to a range of domains of voice function and request or be recommended to participate in professional voice support. Research into this area needs to be intensified so that a more in-depth understanding of the potential voice problems GD peopleAFAB might experience can be produced and members of this group can be provided with more comprehensive, evidence-based, and high-quality professional support if and when they need it.

Role of voice rest following laser resection of vocal fold lesions: A randomized controlled trial.

Voice rest is often prescribed following phonosurgery by most surgeons despite limited empiric evidence to support its practice. This study assessed the effect of postphonosurgery voice rest on vocal outcomes. Prospective, randomized controlled trial. Patients with unilateral vocal fold lesions undergoing CO2 laser excision were recruited in a prospective manner and randomized into one of two groups: 1) an experimental arm consisting of 7 days of absolute voice rest, or 2) a control arm consisting of no voice rest. The primary outcome measure was the Voice Handicap Index-10 (VHI-10) questionnaire. Secondary outcomes included aerodynamic measurements (maximum phonation time), acoustic measures (fundamental frequency, jitter, shimmer, and harmonic-to-noise ratio), and auditory-perceptual measures. Primary and secondary outcomes were assessed preoperatively and reassessed postoperatively at the 1- and 3-month follow-up. Patient compliance to voice rest instructions were controlled for using subjective and objective parameters. Thirty patients were enrolled with 15 randomized to each arm of the study. Statistical analysis for the entire cohort showed a significant improvement in the mean preoperative VHI-10 compared to postoperative assessments at 1-month (19.0 vs. 7.3, P < .05) and 3-month (19.0 vs. 6.2, P < .05) follow-up. However, between-group comparisons showed no significant difference in postoperative VHI-10 at either time point. Similarly, secondary outcome measures yielded no significant difference in between-group comparisons. Our study shows no significant benefit to voice rest on postoperative voice outcomes as determined by patient self-perception, acoustic variables, and auditory-perceptual analysis. 1b CLINICAL TRIAL NUMBER: NCT02788435 (clinicaltrials.gov) Laryngoscope, 130:1750-1755, 2020.

Voice Quality and Auditory Processing in Subjects with and Without Musical Experience

The relationship between voice and auditory processing is complex and has aroused increasing scientific interest in the last decades. Little is known about the relationship between voice quality and auditory processing in individuals with and without musical experience. To assess voice quality and auditory processing in subjects with and without musical experience. Total 120 individuals were split into three groups: GS = singers (N = 47), GI = instrumentalists (N = 43), and NM = nonmusicians (N = 30); group GS was subdivided into GS = 20 singers only and GSI = 27 singers and instrumentalists at the same time. Subjects were undertaken vocal assessment by means of Perceptual Assessment of voice recording followed by self-assessment of a potential voice problem using the Brazilian validated version of the Voice Symptom Scale (VoiSS) (Escala de Sintomas Vocais - ESV). The central auditory processing was carried out following such temporal processing tests: Frequency Pattern Test (FPT), Random Gap Detection Test (RGDT), and auditory-perceptual analysis of distorted speech as indicated: Synthetic Sentence Identification (SSI) test, with Ipsilateral Competing Message. GSI reported a higher number of voice symptoms compared to the other groups for the VoiSS. Throughout the groups, most individuals did not present voice disorders and, when presented, were mild. Subgroup GSI showed the best auditory abilities of temporal ordering for the FPT-Humming and FPT-Verbal, whereas NM had the worst performance. Negligible correlation strength alone was found between the different central auditory processing tests, the overall degree of vocal deviation in the auditory-perceptual analysis of voice quality, and the total score of the Voice Symptom Scale protocol. The voice quality of musicians and nonmusicians was correlated with their auditory processing; although with negligible strength. It was verified that singers-instrumentalist reported more voice symptoms compared to the other groups. Despite the large variation throughout the groups concerning auditory processing, musicians, especially singers-instrumentalists, have shown better auditory abilities of temporal ordering, suggesting that musical training and experience may account for such performance.

Gender-specific reference ranges of the vocal extent measure in young and healthy adults

Objective: The recently developed vocal extent measure (VEM) quantifies a patient’s vocal capacity as documented in the voice range profile (VRP). This study presents the first reference ranges of the VEM for young subjects without voice complaints. Furthermore, this study investigates the influence of gender on the VEM as well as the correlation of the VEM with the dysphonia severity index (DSI).Patients and methods: Reference ranges were captured by combining a retrospective analysis of subjects who received a medical fitness certificate of a healthy voice (n = 135) and a prospective analysis of adult volunteers without voice complaints (n = 67). Every participant obtained a standardized voice assessment comprising videolaryngostroboscopy, auditory-perceptual analysis, acoustic analysis, VRP, and the Voice Handicap Index (VHI-9i).Results: A total of 202 subjects were recruited and investigated. Due to our stringent selection criteria, 51 participants had to be excluded from further analysis. The remaining data of 151 participants (52 males, 99 females), aged 18–39 years (mean 24, SD 5), were analysed in more detail. The mean of the VEM amounted to 123.7 (SD 12.6) for males and 114.4 (SD 13.3) for females. The values differed significantly between both sexes and correlated significantly with the corresponding DSI values.Conclusion: By introducing the first reference values, this study represents the next step of implementing the VEM in daily phoniatric diagnostics. These values serve as a basis to interpret the VEM regarding the degree of severity of voice disorders and to evaluate treatment success.

Formulation of a program for treatment of childhood dysphonia

BackgroundDysphonia is a disorder characterized by change in voice quality, pitch, loudness, or vocal effort that impairs communication or reduces voice-related quality of life. Childhood dysphonia has several adverse educational and psychosocial implications. Dysphonic children are not aware or not bothered by their voice disorder. Although dysphonia might, in some cases, improve by itself in adulthood, it can be of important value to treat the dysphonic voice already during childhood.AimThe aim of this study was to adapt and formulate a program of voice intervention for childhood dysphonia and apply it on Egyptian children to explore its effectiveness as a therapeutic tool.Patients and methodsThis study was conducted on 20 children of both sexes attending the Phoniatrics Unit in Alexandria Main University Hospital complaining of dysphonia. The remediation program aims to improve dysphonia in children using a combination of indirect and direct treatment techniques. It is a modification of The Boone Voice Program for Children combined with new technologies such as the voice games by Kay Elementrics. It is designed to provide the clinician with step-by-step procedures and materials to remediate voice disorders in school-aged children. The program was translated to Arabic and a number of modifications were done in order to adapt it to the Egyptian children.ResultsThe study showed effectiveness of the remediation program for childhood dysphonia regarding some of the auditory perceptual assessment and acoustic analysis values. Some of the laryngeal examination findings also showed improvement post-therapy. The study showed significant relation between the children’s age, sex, diagnosis, and some pretherapy and post-therapy findings.ConclusionData from the current study suggests that voice therapy may prove to be a valid alternative to just planned follow-up.