Auditory-perceptual Assessment Of Voice Research Articles

Can Resident Auditory-Perceptual Voice Assessments Predict Medical Urgency of Voice Disorders?

Growing reliance on telemedicine has created new triaging challenges. This study investigated how effectively otolaryngology resident auditory-perceptual voice assessments performed via telemedicine determined the need for urgent in-person clinic visits. Twelve otolaryngology resident physicians (PGY1-PGY5) performed auditory-perceptual assessments on 25 voice samples recorded during initial voice evaluations. Voice samples were balanced in severity and taken in equal numbers from patients with the following diagnoses: benign laryngeal lesions, laryngeal cancer, functional voice disorders, laryngeal edema (associated with LPR), and laryngeal paralysis/paresis. Urgent diagnoses were defined as laryngeal cancer and severe unilateral laryngeal paralysis. For each voice sample, residents were initially blinded to patient medical history. Residents rated severity of voice disorder, predicted patient diagnosis, and determined the urgency of seeing the patient in clinic. Residents then reviewed information from the patient's medical history and again rated urgency of voice disorder. On average, residents identified urgent voice disorders in 56% of cases. After reviewing medical history, this number significantly increased to 77% (P=0.001). Voice severity, smoking history, time since onset, and course of symptoms were considered most influential when determining medical urgency of voice patients. Year in residency program had no effect on rating accuracy. As expected, diagnostic accuracy of auditory-perceptual assessments was low, ranging from 40% for laryngeal paralysis/paresis to 5% for laryngeal edema. Auditory-perceptual voice assessment, combined with medical history, predicted most medically urgent voice disorders. Further work should investigate if task-specific training might improve these results and which medical history items are most critical. Until accuracy of auditory-perceptual assessment of medical urgency is improved, these data underscore the importance of laryngeal examination in identifying medical urgency and etiology of dysphonia.

Comparison between Voice Disorders among Female Professional and Nonprofessional Voice Users Dealing with Early School Aged Children

Abstract Background Voice disorders are common among females; a main cause is their continuous communication with children as their caregivers. Teachers are exposed to voice abuse and misuse and so also housewives, both of them use their voice excessively to deal with children. Aim of the Work The aim of this study is to compare between voice disorders among female professional and non-professional voice users, in order to identify voice problems affecting nonprofessional voice users for prevention, early detection and proper management to avoid serious vocal health injuries. Study Design a comparative cross-sectional study. Patients and Methods This study included 100 adult female patients who complained of symptoms of voice disorders and were subjected for voice evaluation at the Phoniatrics Unit, Ain Shams University Hospitals. The participated patients were aged between 20 years to 50 years and were divided into 2 groups 50 in each group, group I (teachers) and group II (housewives). Detailed history taking, auditory perceptual assessment of voice (APA), video-laryngoscopic examination, documentation of the auditory perceptual assessment, acoustic analysis and application of Arabic VHI (voice handicap index) were done for all cases. Results The duration of the voice complaint was longer in teachers than housewives. There was nonsignificant difference between both groups regarding the presence of phonasthenic symptoms. The impact of compliant regarding patients own rating of the severity and effect on daily life was higher` in housewives than in teachers, but there was non-significant difference between both groups regarding the listener reaction. There was non-significant difference between teachers and housewives as regard the APA in the overall grade of dysphonia and voice quality. The most prevalent diagnosis of voice disorders among teachers was the vocal fold nodules, while phonasthenia was the most prevalent in housewives. There was a significant difference between the teachers and housewives as regard the total score, functional and emotional subscales of VHI. Results of the acoustic analysis revealed a significant difference between teachers and housewives as regard average F0, jitter % where teachers had higher scores than housewives. While there was non-significant difference as regard RAP, shimm%, APQ and NHR between both groups. A significant positive correlation was found between number of children and functional, emotional and total VHI score in housewives group. There was a significant positive correlation between number of students and patient’s own rating of severity and years of teaching in teachers group. Moreover, there was a highly significant positive relation between having children and emotional subscale of VHI in teachers group. Also, there was a significant positive relation between number of children and functional subscale of VHI in housewives group. Conclusion Voice disorders are common among housewives (Nonprofessional voice users) the same as in teachers (Professional voice users) especially when dealing with early school aged children. Recommendation There is need to increase awareness among the housewives about the importance of voice in their daily life, risk factors for voice problems, how to protect themselves from developing vocal pathologies and when to consult the medical professional.

Comparison and Relation Between Vocal Tract Discomfort and Voice Handicap Index in Teachers With and Without Muscle Tension Dysphonia

Objective One of the most voice-related complaints in teachers is vocal tract discomfort (VTD) which can increase the voice handicap index (VHI) to different degrees. In teachers Muscle Tension Dysphonia (MTD), increases voice complaints and decreases the voice-related quality of life. The aims of this study were to evaluate and compare the frequency and severity subscales of the VTD score and total score of VHI and determine the relation between them in primary school teachers with and without MTD. Materials & Methods This study was cross-sectional and was performed on 80 primary female teachers with and without MTD. The participants in both groups were randomly selected after checking the inclusion criteria. Voice history, auditory-perceptual assessment of voice, palpation, and laryngeal video-stroboscopy were assessed on the teachers in two groups. Then, asked the participants to complete the Persian versions of the VTD and VHI scales. After determining the normal distribution of the data using the Kolmogorov-Smirnov test, the results of VTD, VHI, and their subscales were compared between two groups with an independent t-test. Also, the relationship between them was assessed with the Pearson correlation coefficient analysis. Results The mean score of the frequency subscale of VTD in teachers with MTD was more than in teachers without MTD (30.17±5.11, 8.22±2.26), respectively. The score of severity subscales of VTD in teachers with MTD was 39.12±4.94 and in teachers without MTD was 7.89±2.13. Also, the total score of the VHI questionnaire in teachers with MTD was significantly higher than teachers without MTD (P<0.05). Moreover, there was a significant positive correlation between the frequency and severity subscales of VTD and the total score of VHI in the two groups (P<0.05). Conclusion This study showed the frequency and severity scores of the VTD and the degree of VHI experienced by MTD are remarkably higher than teachers without MTD. The authors emphasize on the use of VTD and VHI scales in screening teachers who are at risk of voice problems, and the researchers pointed out the importance of paying attention to the reduction of discomfort feelings in the vocal tract and voice handicap in the voice therapy sessions of teachers with MTD.

Treinamento para análise perceptivo-auditiva da voz: revisão de escopo

ABSTRACT Purpose To synthesize the state of scientific knowledge about training for auditory-perceptual voice analysis. Research strategy Question, Concept and Context and combinations of descriptors were formulated for searching in PubMed/Medline, LILACS and SciELO databases. Selection criteria Studies were included with a population composed of listeners with or without experience in auditory-perceptual analysis, which included auditory-perceptual voice analysis, in the context of vocal clinic, using human and/or synthesized voices, with individual or group training. Training method, voices used, training time and whether there was training in central auditory skills were observed. Results It is common to use auditory anchors, feedback, breathy and rough natural voices and training time with a maximum duration of two hours. No study applied the training of central auditory processing skills in training for auditory-perceptual voice assessment. Conclusion There is still no consensus on what is the best training program for auditory-perceptual voice analysis.

Deep learning in automatic detection of dysphonia: Comparing acoustic features and developing a generalizable framework.

Auditory-perceptual assessment of voice is a subjective procedure. Artificial intelligence with deep learning (DL) may improve the consistency and accessibility of this task. It is unclear how a DL model performs on different acoustic features. To develop a generalizable DL framework for identifying dysphonia using a multidimensional acoustic feature. Recordings of sustained phonations of /a/ and /i/ were retrospectively collected from a clinical database. Subjects contained 238 dysphonic and 223 vocally healthy speakers of Chinese Mandarin. All audio clips were split into multiple 1.5-s segments and normalized to the same loudness level. Mel frequency cepstral coefficients and mel-spectrogram were extracted from these standardized segments. Each set of features was used in a convolutional neural network (CNN) to perform a binary classification task. The best feature was obtained through a five-fold cross-validation on a random selection of 80% data. The resultant DL framework was tested on the remaining 20% data and a public German voice database. The performance of the DL framework was compared with those of two baseline machine-learning models. The mel-spectrogram yielded the best model performance, with a mean area under the receiver operating characteristic curve of 0.972 and an accuracy of 92% in classifying audio segments. The resultant DL framework significantly outperformed both baseline models in detecting dysphonic subjects on both test sets. The best outcomes were achieved when classifications were made based on all segments of both vowels, with 95% accuracy, 92% recall, 98% precision and 98% specificity on the Chinese test set, and 92%, 95%, 90% and 89%, respectively, on the German set. This study demonstrates the feasibility of DL for automatic detection of dysphonia. The mel-spectrogram is a preferred acoustic feature for the task. This framework may be used for vocal health screening and facilitate automatic perceptual evaluation of voice in the era of big data. What is already known on this subject Auditory-perceptual assessment is the current gold standard in clinical evaluation of voice quality, but its value may be limited by the rater's reliability and accessibility. DL is a new method of artificial intelligence that can overcome these disadvantages and promote automatic voice assessment. This study explored the feasibility of a DL approach for automatic detection of dysphonia, along with a quantitative comparison of two common sets of acoustic features. What this study adds to existing knowledge A CNN model is excellent at decoding multidimensional acoustic features, outperforming the baseline parameter-based models in identifying dysphonic voices. The first 13 mel-frequency cepstral coefficients (MFCCs) are sufficient for this task. The mel-spectrogram results in greater performance, indicating the acoustic features are presented in a more favourable way than the MFCCs to the CNN model. What are the potential or actual clinical implications of this work? DL is a feasible method for the detection of dysphonia. The current DL framework may be used for remote vocal health screening or documenting voice recovery after treatment. In future, DL models may potentially be used to perform auditory-perceptual tasks in an automatic, efficient, reliable and low-cost manner.

Patient reported voice handicap and auditory-perceptual voice assessment outcomes in patients with COVID-19

Purpose The purpose of this study is to compare patient-reported voice handicap and auditory-perceptual measures of voice between healthy individuals and COVID-19 patients, as well as to investigate the effect of clinical factors on voice quality. Methods COVID-19 patients (n = 138) and 90 healthy controls were included in the study. The Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) was used to grade voice samples based on overall severity, roughness, breathiness, strain, pitch, and loudness. The Voice Handicap Index-10 was completed by all participants (VHI-10). Physical (pVHI), emotional (eVHI) and functional (fVHI) subscores were calculated. Clinical data were collected (disease stage, CT grade, neutrophil/lymphocyte ratio, CRP, and symptoms). Results A statistically significant difference between patient and control groups in VHI-10 and CAPE-V scores was detected (p < 0.001). Except eVHI, total score and all subscale scores were higher in patients with COVID-19 as the pVHI was the most affected (η2 = 0.324) subscale. All scores of CAPE-V were significantly worse in patients with COVID-19 as highest impact of COVID-19 was on breathiness (η2 = 0.518). Pre-existing pulmonary comorbidity, dyspnoea and N/L was significantly associated with the VHI-10 overall score (βpc = 4.27, βdyspnoea = 5.69 and βnl = 0.25). The overall severity of CAPE-V was significantly dependent on dyspnoea and pulmonary comorbidity (βdyspnoea = 11.25, βpc = 10.12). VHI ≥4 and CAPE-V overall severity ≥11 were good indicators of COVID-19 related dysphonia. Conclusions COVID-19 causes patient-reported voice handicap and deteriorates auditory-perceptual measures of voice. COVID-19 related voice impairment was mainly associated with the decreased respiratory capacity.

Acoustic Variability in the Healthy Female Voice Within and Across Days: How Much and Why?

Purpose The aims of this study were (1) to quantify variability in voice production (as measured acoustically) within and across consecutive days in vocally healthy female speakers, (2) to identify which acoustic measures are sensitive to this variability, and (3) to identify participant characteristics related to such voice variability. Method Participants included 45 young women with normal voices who were stratified by age, specifically 18-23, 24-29, and 30-35 years. Following an initial acoustic and auditory-perceptual voice assessment, participants performed standardized field voice recordings 3 times daily across a 7-day period. Acoustic analyses involved 32 cepstral-, spectral-, and time-based measures of connected speech and sustained vowels. Relationships among acoustic data and select demographic, health, and lifestyle (i.e., participant-based) factors were also examined. Results Significant time-of-day effects were observed for acoustic analyses within speakers (p < .05), with voices generally being worse in the morning. No significant differences were observed across consecutive days. Variations in voice production were associated with several participant factors, including improved voice with increased voice use; self-perceived poor voice function, minimal or no alcohol consumption, and extroverted personality; and worse voice with regular or current menstruation, depression, and anxiety. Conclusions This acoustic study provides essential information regarding the nature and extent to which healthy voices vary throughout the day and week. Participant-based factors that were associated with improved voice over time included increased voice use, self-perceived poor voice function, minimal or no alcohol consumption, and extroverted personality. Factors associated with worse voice production over time included regular or current menstruation, and depression and anxiety.

Vocal Disorders in Patients with COVID 19 in Egypt.

COVID-19 is considered a respiratory disease which has many symptoms associated with the larynx and the lungs infections. COVID-19 has wide spectrum of clinical features starting from mild symptoms to severe illness. Otolaryngological symptoms as nasal obstruction, loss of smell, taste dysfunction, sore throat, sticky mucus, and dysphagia are common in COVID-19 patients. Other vocal symptoms as dysphonia and phonesthenia are common in COVID-19 patients. The aim of this study is to detect the occurrence of vocal symptoms in COVID-19 patients in Egypt and to investigate the videolaryngoscopic findings associated with these symptoms. A total number of 106 patients diagnosed with COVID-19 were randomly assessed for vocal symptoms. The following epidemiological and clinical data were collected: age, gender, smoking consumption, general symptoms, otolaryngological and vocal symptoms as dysphonia and phonesthenia. Auditory perceptual assessment of voice and videolaryngoscopic examination were done. The occurrence of dysphonia and phonesthenia were observed in COVID -19 patients. Of the 106 patients, 84 patients (79%) were dysphonic, 20 (18.8%) patients were phonesthenic. The correlation of the different otolaryngological symptoms with dysphonia and phonesthenia were reported. A significant correlation was found between dysphonic patients and rhinorrhea, taste dysfunction, sore throat, and cough. A significant correlation was found between phonesthenic patients and allergic rhinitis. Videolaryngoscopic findings were detected in COVID-19 patients. Vocal fold congestion was found in 42 patients (39.6%), benign vocal fold swellings was found in 18 patients (16.9%), ventricular hypertrophy was found in 6 patients (0.05%), unilateral vocal fold immobility was found in 14 patients (13.2%), and vocal fold congestion associated with ventricular fold hypertrophy was found in 20 patients (18.8%).There was significant correlation of dysphonia and phonesthenia with vocal fold congestion (P value:0.001, P value:0.039 respectively).There was a significant correlation between cough and vocal fold congestion (P value: 0.000). Benign vocal fold swellings were associated with 18 patients (16.9%), but it was not statistically significant (P value: 0.931). Dysphonia and phonesthenia were observed in patients with mild to moderate COVID-19.The vocal symptoms were associated with different laryngoscopic findings, in which, vocal fold congestion was the commonest.

Cultural and Linguistic Adaptation of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) Into Hindi.

Aim The purpose of this study was to develop and assess the reliability of a Hindi version of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V). Reliability was assessed by comparing Hindi CAPE-V ratings with English CAPE-V ratings and by the Grade, Roughness, Breathiness, Asthenia and Strain (GRBAS) scale. Method Hindi sentences were created to match the phonemic load of the corresponding English CAPE-V sentences. The Hindi sentences were adapted for linguistic content. The original English and adapted Hindi CAPE-V and GRBAS were completed for 33 bilingual individuals with normal voice quality. Additionally, the Hindi CAPE-V and GRBAS were completed for 13 Hindi speakers with disordered voice quality. The agreement of CAPE-V ratings was assessed between language versions, GRBAS ratings, and two rater pairs (three raters in total). Pearson product-moment correlation was completed for all comparisons. Results A strong correlation (r > .8, p < .01) was found between the Hindi CAPE-V scores and the English CAPE-V scores for most variables in normal voice participants. A weak correlation was found for the variable of strain (r < .2, p = .400) in the normative group. A strong correlation (r > .6, p < .01) was found between the overall severity/grade, roughness, and breathiness scores in the GRBAS scale and the CAPE-V scale in normal and disordered voice samples. Significant interrater reliability (r > .75) was present in overall severity and breathiness. Conclusions The Hindi version of the CAPE-V demonstrates good interrater reliability and concurrent validity with the English CAPE-V and the GRBAS. The Hindi CAPE-V can be used for the auditory-perceptual voice assessment of Hindi speakers.

Construct and Discriminant Validity of the Persian Version of the Consensus Auditory Perceptual Evaluation of Voice (CAPE-V)

Five dimensions of voice assessment are considered as visual evaluation, videostroboscopy, acoustic, aerodynamic, patient-based, and auditory-perceptual. Auditory-perceptual voice assessment scales are the standard scales for clinicians to document voice therapy outcomes in dysphonic patients. The primary objective of the present study was to investigate the construct and discriminant validities of the Persian Version of the CAPE-V (ATSHA). A secondary objective was to determine the differences between experienced and inexperienced raters in the auditory-perceptual assessment of voice. Forty normal and forty individuals with dysphonia were rated by five experienced and five inexperienced raters. Pathological subgroups were vocal fold nodules, vocal fold polyps, unilateral vocal fold paralysis (UVFP), and Reinke's edema. The differences between normal and pathologic groups were observed by independent t tests for all perceptual parameters (P < 0.05). Construct validity was documented for the scale of interest. The Kruskal-Wallis and Mann-Whitney comparisons were used to examine discriminant validity. Findings of these tests showed that scores of all pathological subgroups were significantly different except for the parameter of "strain" in sustained vowels (P < 0.05). Results of the Wilcoxon Matched-Pairs Signed Rank Test indicated that experienced and inexperienced raters were significantly different in auditory-perceptual judgments of voice. It seems that the Persian Version of the CAPE-V is a consistent predictor of normal and pathological voices. Moreover, we found that experienced listeners have different auditory-perceptual skills in evaluation of voice that make them more precise than inexperienced listeners.

Predictive Value of Auditory Perceptual Assessment of Voice in Diagnosis of Functional Voice Disorders and Minimal Associated Pathological Lesions

Background: Auditory perceptual assessment is considered the preliminary assessment tool of disordered voice quality. The validity of perceptual measurement depends on characteristics of the raters and the stimuli. It is associated with minimal cost and no specialized instrumentation is required. Because auditory-perceptual evaluation of dysphonia has been heavily criticized on the basis of its reliability and validity, we conducted this study to assess the reliability of auditory perceptual assessment as one of the objective measures for assessment of voice disorders and to determine the predictive relationships between instrumental measures as endoscopic examination and perceptual ratings of impaired voice quality. Subjects and Methods: The study included 50 patients complaining of dysphonia with age ranges from 5 -61 years. Auditory perceptual assessment (APA) of patients’ voices was done and voice recordings were assessed by three experienced phoniatricians in a double blind, randomized fashion. The examiners (Ex1.2.3) assessed the recorded voice quality by using the modified GRBAS scale. Laryngoscopic examination was performed using indirect laryngoscope, flexible fibrotic laryngoscopy as well as rigid laryngoscope. Results: Results showed considerable similarities among raters in assessing the disordered voice quality especially on assessing the overall grade of dysphonia and the “Strain” voice quality with strong inter-rater reliability (Cronbach's Alpha) was 0.780 and 0.710 respectively. However, data showed some differences with poor inter-rater reliability especially for ratings of glottal attack and associated laryngeal function as cough (Cronbach's Alpha) was 0.383 and 0.531 respectively. The study also showed significant relations on comparing between instrumental (video endoscopic) diagnosis and perceptual predictive diagnosis of patients’ disordered voice quality according to two of the raters with P <0.03&0.04. Conclusion: This study showed considerable variability of the inter-rater reliability across parameters of disordered voice quality with high inter-rater reliability for some parameters and low for others. Yet, there was a strong association between instrumental diagnostic measures and the perceptual predictive diagnosis denoting a clear relationship between listener’s judgments of disordered voice quality and the underlying vocal pathology; a thing that is in favor for the validity of APA as a popular and fundamental tool for the assessment of vocal impairment.

Voice Disorders after Intubation: The Importance of Intra-Operative Monitoring and Controlling of Endo-Tracheal Tube Cuff Pressure in Reducing Intubation-Related Complications

AbstractBackground: The importance of monitoring and controlling endotracheal tube cuff (ETTc) pressure in reducing larynge-otracheal injuries and intubation-related respiratory compli-cations has been previously investigated by several authors. However, little is known about the role of controlling ETT cuff pressure in minimizing transient voice changes following endotracheal intubation.Aim of the Study: The aim of this study was to investigate the importance of monitoring and controlling ETTc pressure in reducing voice disorders after endotracheal intubation.Patients and Methods: Fifty patients in the age between 18-50 years, undergoing middle ear surgery were enrolled into the study. Patients were randomized by means of individ-ually prepared envelopes to either the control group (n=25), without measuring ETTc pressure, or the study group (n=25), with ETTc pressure measurement. All patients were examined pre-operatively to determine baseline values, 24 hours after surgery and 1 week post-operatively. Phoniatric examination included auditory perceptual assessment, videolaryngoscopy and acoustic analysis of voice. Statistical analysis included the arithmetic mean, Standard Deviation (SD), standard error, hypothesis student's t and Spearman's rank-order correlation tests. p-values <0.05 were chosen as the level of significance.Results: Auditory perceptual assessment of voice per-formed one day after extubation indicated the presence of post-intubation dysphonia which was of a mild to moderate grade, an irregular quality, a low pitch and fluctuating loudness. These changes were more pronounced and occurred more frequently in patients of the control group in whom the cuff pressure was adjusted by pilot balloon palpation according to the experience of the anaesthesiologist. One week after surgery, all patients belonging to the study group, in whom a hand-held cuff pressure monitor was used to adjust the cuff pressure, showed improvement in all the perceived parameters, whereas persistent dysphonia was still perceived in two patients of the control group. Videolaryngoscopy performed before intubation showed that all patients were free from any laryngeal lesions. One day after extubation, there was evidence of traumatic laryngeal lesions in the form of vocal fold congestion in 5 patients (20%) of the control group and 3 patients (12%) of the study group. One week after extubation, residual lesions were still present in 3 patients (12%) of the control group in the form of mild vocal fold edema in one patient and vocal fold congestion in two other patients. Acoustic analysis of voice performed 24 hours after extubation showed a highly significant increase in fundamental frequency F0 in both male and female patients of the control group. These changes were accompanied by a significant increase in jitter in only the female patients. By contrast, acoustic analysis of voice recorded both 24 hours and one week after extubation in patients belonging to the study group did not show any significant changes in any of the measured parameters when compared to their corresponding baseline values. An inter-group com-parison of the post-operative parameters recorded by acoustic analysis of voice one day after extubation showed a statistically highly significant (p=0.013) reduction in fundamental fre-quency F0 by 75% among male patients, and a statistically significant (p=0.05) reduction in jitter by 74% in females belonging to the study group when compared to those of the control group. Shimmer and NHR increased to 78% and 47%, respectively, in male patients belonging to the study group, and decreased in females, but these changes were statistically not significant.Correlation performed between the changes in parameters obtained by acoustic analysis of voice and the duration of intubation showed a statistically significant (p-value=0.023) positive correlation between the changes in fundamental frequency F0 and the duration of intubation. Likewise, a significant (p-value=0.016) positive correlation was found between the changes in jitter and the duration of intubation.Conclusion and Future Recommendations: General an-aesthesia has multisystem effects, some of which can disturb the fine harmony necessary for voice production. Even short-term intubation is usually followed by a period of dysphonia that may extend after extubation anywhere from 12 hours to more than five days. Proper control of endotracheal tube cuff (ETTc) pressure by a manometer helps reduce ETT-related postprocedural complications. Acoustic analysis may be used to identify and monitor even minor laryngeal trauma resulting from the procedure. Jitter and shimmer are the best indicators of post-intubation phonation changes. For medicolegal reasons, patients scheduled for general anesthesia should be informed about the possible post-operative voice changes that could last longer than one day. We further recommend routine intraoperative monitoring of endotracheal tube cuff pressure, in additition to post-operative phoniatric assessment and follow-up of the patients for early post-operative diagnosis and treatment of dysphonia.

Effect of the comprehensive voice rehabilitation program in teachers with behavioral dysphonia.

Analyze the effects of the Comprehensive Vocal Rehabilitation Program (CVRP) and the motivational stages during speech therapy in teachers with behavioral dysphonia. Retrospective, longitudinal, observational study using data from the medical records of 33 teachers regarding auditory-perceptual, acoustic, self-perception analyses and the Voice Handicap Index (VHI-10) protocol in pre- and post-speech therapy situations, and motivational stages of adherence to treatment. Auditory-perceptual assessment of the voice showed that 64.7% of the participants improved voice quality post-speech therapy. Comparison between the pre- and post-speech therapy moments showed that 82.4% of the teachers improved their voice according to self-perception. The VHI-10 showed no statistically significant difference between the pre- and post-speech therapy moments (p=0.879). Acoustic analysis of the voice showed improvement in the means of all evaluated parameters. Statistically significant correlation was observed in the analysis between the pre- and post-speech therapy moments only for the variables maximum phonation time and shimmer. Most of the teachers were at the stage of contemplation on the URICA-VOICE scale. No statistical significance was observed in the correlation analysis between VHI-10, auditory-perceptual assessment of the voice, maximum phonation time, and parameters of acoustic analysis with vocal self-perception of teachers and with auditory-perceptual assessment of voice. The use of CVRP for the treatment of behavioral dysphonia presented positive results in the pre- and post-speech therapy evaluation. As for motivation, the teachers strongly believed in the possibility of facing the problem, but still without much effort to change this situation.

Voice Assessment Pre- and Post-Adenotonsillectomy in Children.

Objective Changes in vocal patterns after adenotonsillectomy are questionable. Few studies have assessed acoustic voice changes before and after adenotonsillectomy. The objective of this study wasto evaluate the impact of adenotonsillectomy on the voice of children with adenotonsillar hypertrophy. Participants and Methods The study included fifty children ranging in age between 4 and 12 years, with adenotonsillar hypertrophy, indicated for adenotonsillectomy. Auditory perceptual assessment of speech included nasality, degree of hyponasality, degree of open nasality, and degree of dysphonia. Acoustic analysis was carried out before and after one month and three months of surgery, using multidimensional voice program software (MVDP). The vowels were analyzed as to their acoustic parameters: fundamental frequency (Hz), jitter (%), shimmer (dB) and noise-harmony ratio (NHR; dB). Results At oneand threemonths after surgery, preoperative readings were of F0 score while jitter and shimmer normalized only at the 3rd month. There were significant differences between readings at one month and threemonths of F0 and jitter. Auditory perceptual assessment(APA) of voice (dysphonia) and APA of speech (hyponasality) significantly improved at 1st and 3rd month after surgery with significant differences between results of 1st and 3rd month. Harmonic noise ratio (HNR) had negative, significantly fair correlation with APA of Voice (dysphonia). Conclusion Hyponasal speech and with dysphonia preoperatively often have normal resonance and voice following adenotonsillectomy. Objective and subjective evaluation of speech and voice can help the specialist in the management of patients with adenotonsillar hypertrophy.

Turkish Standardized Reading Passage for the Evaluation of Hard Glottal Attack Occurrence Frequency

This study aimed to develop a Turkish reading passage that can be used in evaluating the frequency of hard glottal attack (HGA) and to assess its reliability. This is a prospective case-control study. The Towne-Heuer reading passage is a valuable tool that can be used for the auditory-perceptual assessment of voice. The characteristics of the first four paragraphs of the reading passage were analyzed by a linguist. Then, a Turkish reading passage with similar characteristics was developed. The control group (n = 21) consisted of individuals with no voice disorder. The study group consisted of two subgroups that were diagnosed as having vocal fold nodules (n = 11) and muscle tension dysphonia (n = 10). A total of three listeners were evaluated for the frequency of HGAs. One of the listeners was a master's student, whereas the other two listeners were speech-language pathologists. Consistency between the listeners was evaluated by using the percent agreement and the kappa statistics. Intrarater reliability was assessed by the Wilcoxon sign test. The t test was used to evaluate potential differences between the groups. The results were considered as significant if the P value was <0.05. The average attack number in the study group was found to be significantly higher than the controls (P < 0.05). No significant difference could be discerned between the muscle tension dysphonia and vocal nodule subgroups (P > 0.05). Findings confirmed that HGAs are clearly related to the vocal hyperfunction; however, the mechanism of action needs more research. In addition, the relationship between syllable stress and HGA should be further researched to clarify the cause of the attack number differences between English and Turkish languages.

The Influence of Native Language on Auditory-Perceptual Evaluation of Vocal Samples Completed by Brazilian and Canadian SLPs

This study aimed to determine the influence of native language on the auditory-perceptual assessment of voice, as completed by Brazilian and Anglo-Canadian listeners using Brazilian vocal samples and the grade, roughness, breathiness, asthenia, strain (GRBAS) scale. This is an analytical, observational, comparative, and transversal study conducted at the Speech Language Pathology Department of the Federal University of Minas Gerais in Brazil, and at the Communication Sciences and Disorders Department of the University of Alberta in Canada. The GRBAS scale, connected speech, and a sustained vowel were used in this study. The vocal samples were drawn randomly from a database of recorded speech of Brazilian adults, some with healthy voices and some with voice disorders. The database is housed at the Federal University of Minas Gerais. Forty-six samples of connected speech (recitation of days of the week), produced by 35 women and 11 men, and 46 samples of the sustained vowel /a/, produced by 37 women and 9 men, were used in this study. The listeners were divided into two groups of three speech therapists, according to nationality: Brazilian or Anglo-Canadian. The groups were matched according to the years of professional experience of participants. The weighted kappa was used to calculate the intra- and inter-rater agreements, with 95% confidence intervals, respectively. An analysis of the intra-rater agreement showed that Brazilians and Canadians had similar results in auditory-perceptual evaluation of sustained vowel and connected speech. The results of the inter-rater agreement of connected speech and sustained vowel indicated that Brazilians and Canadians had, respectively, moderate agreement on the overall severity (0.57 and 0.50), breathiness (0.45 and 0.45), and asthenia (0.50 and 0.46); poor correlation on roughness (0.19 and 0.007); and weak correlation on strain to connected speech (0.22), and moderate correlation to sustained vowel (0.50). In general, auditory-perceptual evaluation is not influenced by the native language on most dimensions of the perceptual parameters of the GRBAS scale.

The Value of Vocal Extent Measure (VEM) Assessing Phonomicrosurgical Outcomes in Vocal Fold Polyps

This study aimed to present vocal extent measure (VEM), demonstrate its changes with phonomicrosurgical treatment in patients with vocal fold polyps (VFPs), and to compare its performance to that of established vocal parameters. This is an individual cohort study. Microlaryngoscopic ablation was executed in 61 patients with manifestation of VFP (28 male, 33 female; 45 ± 13 years [mean ± SD]). Analysis of treatment outcome was based on pre- and postoperative voice function diagnostics and videolaryngostroboscopy. Examination instruments were: auditory-perceptual voice assessment (roughness, breathiness, and overall hoarseness [RBH]-status), voice range profile (VRP), acoustic-aerodynamic analysis, and patients' self-assessment of voice using the voice handicap index. The VEM, a parameter not yet commonly established in phoniatric diagnostics, was calculated from area and shape of the VRP to be compared with the dysphonia severity index (DSI) concerning diagnostic suitability. All polyps were completely excised. Three months postoperatively, mucosal wave propagation had recovered. All subjective and most objective acoustic and aerodynamic parameters showed highly significant improvement. The VHI-9i-score decreased from 15 ± 8 to 6 ± 7 points. The average total vocal range extended by 4 ± 5 semitones, the mean speaking pitch decreased by 1 ± 2 semitones. The DSI increased on average from 2.6 ± 2.1 to 4.0 ± 2.2, VEM from 83 ± 28 to 107 ± 21 (P < 0.01). VEM and DSI correlated significantly with each other (rs = 0.65; P < 0.01). Phonomicrosurgery of VFP is an objectively and subjectively satisfactory therapy for voice improvement. The VEM represents a comprehensible and easy-to-use unidimensional measure for objective VRP evaluation. This positive measure of vocal function seems to be a compelling diagnostic addition for objective quantification of vocal performance.

Vocal Characteristics of Elderly Women Engaged in Aerobics in Private Institutions of Salvador, Bahia

To characterize the voice of elderly people engaged in aerobics. Collection of phonation /a:/ from 58 elderly people engaged in aerobics for perceptual voice analysis (RASATI scale) and computed acoustics (Multi Dimensional Voice Program Advanced, software of Kay Pentax®, that analyzes up to 33 measures, proposing normal ranges according to sex). The Spearman correlation test was used, with significance level of 5%. The association between auditory-perceptual assessment of voice and acoustic parameters was not statistically significant but showed less vocal quality deviations. The association between acoustic measures and age was only statistically significant result for the measurement of fundamental frequency (f0) and maximum f0 (fhi). There was no correlation between time of aerobics and acoustic measures, but there was correlation of those measurements with age. There was a statistically significant positive correlation between f0 and fhi with minimal roughness and standard deviation of f0 with hoarseness, breathiness, and asthenia; jitter and shimmer measures with hoarseness, breathiness, and asthenia; noise measurements with hoarseness, breathiness, and harshness; measures of breaking voice hoarseness and breathiness; measures of voiceless segments with hoarseness and asthenia; measures of subharmonic with hoarseness; and measures of vocal tremor with breathiness, asthenia, and instability. There was a significant negative correlation between minimum f0 with breathiness; jitter measures with tension; and soft phonation index with roughness and instability. Elderly women engaged in aerobics showed mostly normal voice, with most values of acoustic measures within normal and positive correlations between perceptual and auditory vocals and acoustic aspects that suggest instability, noise, and vocal tremor.

Autoavaliação vocal e avaliação perceptivo-auditiva da voz em mulheres com doença tireoidiana

Objetivo comparar a autoavaliação vocal e a avaliação perceptivo-auditiva da voz em mulheres com doença tireoidiana. Métodos o estudo foi realizado com 40 pacientes do sexo feminino, idade média de 49,50±10,40 anos, utilizando a escala analógica-visual (EAV) para realizar a autoavaliação vocal e a análise perceptivo-auditiva pelo fonoaudiólogo. A paciente considerou a emissão habitual do dia a dia na sua autoavaliação e para a análise fonoaudiológica da voz foram gravadas amostras da contagem de 1 a 20. A análise considerou o tamanho total da amostra e também sua categorização grupos de acordo com a presença ou não de queixa e por faixa etária. A análise descritiva das variáveis considerou média, mediana e desvio-padrão. Foram aplicados os testes de Wilcoxon e Mann-Whitney para comparação de médias e o teste de Spearman para testar correlação entre as duas avaliações.O nível de significância foi de 5%. Resultados 19 (47,5%) pacientes relataram queixa de disfonia. A média e desvio-padrão da EAV das pacientes e da EAV do fonoaudiólogo foram 32,58±27,99 e 37,23±15,92, respectivamente, sem diferença estatisticamente significante. Pacientes com queixa vocal apresentaram pior média na autoavaliação quando comparadas às que não tiveram queixa. Não houve diferença estatisticamente significante entre esses grupos em relação à avaliação perceptivo-auditiva. Não foi encontrada correlação estatisticamente significante entre a percepção que a paciente tem sobre sua voz e a avaliação do fonoaudiólogo. Conclusão não houve diferença entre as médias da autoavaliação vocal e da avaliação perceptivo-auditiva; a autoavaliação da voz foi pior em pacientes com queixa vocal; não houve correlação entre as duas avaliações estudadas.

Effect of adenoid hypertrophy on the voice and laryngeal mucosa in children

IntroductionThe adenoids, or pharyngeal tonsils, are lymphatic tissue localized at the mucous layer of the roof and posterior wall of nasopharynx.Dysphonia defined as perceptual audible change of a patient's habitual voice as self judged or judged by his or her listeners.The diagnosis of dysphonia relies on clinical judgment based on phoniatric symptoms, auditory perceptual assessment of voice (APA) and full laryngeal examination. Patients and methodsOur study was conducted to evaluate the effect of adenoid hypertrophy on voice and laryngeal mucosa. The study sample composed of sixty children, forty of them had adenoid hypertrophy (patient's group) and twenty healthy children (control group). Patient's group composed of 17 boys (42.5%) and 23 girls (57.5%), while control group consists of 8 males (40%) and 12 females (60%). All patients and control group subjected to history taking, clinical examination, lateral soft tissue X-ray on the nasopharynx, APA based on the modified GRBAS scale and full laryngeal examination. The data are collected and analyzed statistically by using software SPSS. ResultsOur results showed that there is a significant association between adenoid hypertrophy and, degree of dysphonia, leaky voice, pitch of voice and laryngeal lesion.Adenoid hypertrophy did not associate with loudness of voice, as well as character (irregular, breathy and strained). Laryngeal lesions were detected in thirteen children from patient group (32.5%): nodules (n=6), thickening (n=5), congestion (n=2), while one child only out of 20 children of the control group had congestion (5.0%). ConclusionOur results showed the importance of the assessment of voice and laryngeal examination in patients with adenoid hypertrophy, also treating the minimal mucosal lesions that results from adenoid hypertrophy should be taken in consideration.