Consensus Auditory-Perceptual Evaluation Research Articles

Vocal profile of 46,XX individuals with congenital adrenal hyperplasia.

Describe the vocal profile of 46,XX congenital adrenal hyperplasia (CAH) patients followed up at the Genetics Outpatient Clinic of the Federal University Bahia (GOC-UFBA). This is a descriptive, exploratory, cross-sectional study. The study sample consisted of 28 volunteers: 14 individuals diagnosed with CAH, followed up by the multiprofessional team of the GOC-UFBA, and 14 46,XX individuals without vocal changes and endocrine and/or genetic pathologies. Voice sample collection was performed individually in a quiet environment with participants properly seated. Acoustic (PRAAT program) and auditory-perceptual (Consensus Auditory-Perceptual Evaluation of Voice - CAPE-V) analyses were conducted. In the qualitative assessment of pitch, eight (61.54%) patients in the CAH group showed low vocal pattern and eight (61.54%) individuals in the group without CAH presented high vocal pattern. There were statistically significant differences between the groups only for the following vocal attributes of the CAPE-V: overall severity (p=0.01), roughness (p=0.00), and pitch (p=0.01). No statistically significant difference was observed in the other acoustic parameters investigated (p>0.05). The present study demonstrated that 46,XX CAH individuals, even when submitted to hormone therapy, present rough, low, deviant voice.

Occurrence of vocal changes in preschoolers with no voice complaints: an auditory-perceptual and acoustic analysis

ABSTRACT Purpose: to verify, with the auditory-perceptual and acoustic parameters, the occurrence of voice changes in children with no voice complaints, per sex. Methods: the registers of 36 children with no voice complaints, aged 6 to 8 years, of whom 19 were males, were assessed. The databank consisted of the recordings of sustained vowels, sentences, and spontaneous speech. The auditory-perceptual analysis was conducted with the Consensus Auditory-Perceptual Evaluation of Voice, and the acoustic analysis, with VoxMetria. The fundamental frequency, jitter, shimmer, noise, and glottal-to-noise excitation ratio were analyzed. The Mann-Whitney test was applied for numerical variables, and the McNemar test, for the categorical ones, at the p < 0.05 significance level. Results: of the 5 children with mild voice changes, 4 were males. The most frequent resonance deviation was the laryngopharyngeal one. There was no difference between the sexes in the auditory-perceptual findings. The fundamental frequency in the group with changes was lower than that in the group without changes. There was a statistical association between the changes in the auditory-perceptual assessment and the acoustic parameters. Conclusion: voice changes occurred in 13.89% of the studied sample of children with no voice complaints, without differences between the sexes in the auditory-perceptual parameters. Vocal deviations were in a mild degree in all children who had them, the most frequent ones being roughness and breathiness. The fundamental frequency and shimmer were the acoustic parameters whose values most often occurred outside the reference limits, in both genders.

The Effects of Collegiate Sports Coaching on the Male Voice: Pilot Data

PurposeThis research gathered pilot data on the effects of a typical collegiate athletic season on the male coach's voice. Materials and methodsTen male coaches and ten age- and sex-matched controls participated. Qualitative and quantitative analyses were performed to assess group differences in: 1) written self-reports obtained during one session, 2) acoustic and aerodynamic variables obtained during regular season and during off-season for the coaches and only once for the controls, and 3) auditory-perceptual data provided by three speech-language pathologists using the Consensus Auditory-Perceptual Evaluation of Voice during one listening session. Data pertaining to the coaches’ regular season, to the coaches’ off-season, and to the control participants were designated as in-season, off-season, and control, respectively. ResultsSignificant self-reported findings included more phonotraumatic behaviors in the coaches than in the controls and higher in-season than off-season and control vocal demand. The coaches’ history of voice problems was unrelated and the controls’ was related to respiratory illness and addressing a large audience. A significant acoustic finding was lower off-season than control low fundamental frequency. Finally, trained listeners perceived control loudness as more aberrant than off-season loudness and they noted vocal fry twice as many times in in-season and off-season than in control voices. ConclusionsThis study exposed traces of adverse voice reactions to coaching and confirmed that coaches harbor a job-based proclivity to voice overuse. Self-reported measures appeared to be the least and aerodynamic the most immune to phonatory exertion that pervades daily coaching tasks. Future studies are warranted to further delineate how athletic coaching interferes with voice production.

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.

Perceptual Voice Qualities Database (PVQD): Database Characteristics

To develop a perceptual voice quality database for educational and research purposes. Development of a database. A total of 296 high quality audio file recordings consisting of sustained /a/ and /i/ vowels and sentences from Consensus Auditory-Perceptual Evaluation of Voice were made in clinical environments. Nineteen experienced voice clinicians rated the audio samples using voice qualities from the Consensus Auditory-Perceptual Evaluation of Voice (without visual anchors) and GRBAS scales. The database includes samples of a wide range of voice quality severities across a wide range of speaker age and sex. Both inter- and intrarater reliabilities were established to be good for the database overall. The database is housed in the Mendeley Data online repository and is free for public use.

Cultural Competency in Voice Evaluation: Considerations of Normative Standards for Sociolinguistically Diverse Voices

Significant differences exist in anatomical, acoustic, and aerodynamic parameters for nonspeech tasks between culturally and linguistically diverse sample populations. There is a need for expansion of the normative acoustic data to include sociolinguistically diverse groups to ensure that clinical objective measurements are accurately classifying the voice quality of all individuals. This study examined objective measures of voice quality assessment of monolingual speakers of Standard American English (SAE) with sequential bilingual, native (L1) French and Spanish speakers on perturbation, noise, spectral/cepstral analyses, and compared ratings on auditory-perceptual assessment with acoustic data secondary to degree of accentedness. Thirty speakers with normal voice quality were rated on the Consensus Auditory-Perceptual Evaluation of Voice scale. Voice quality measures were analyzed using the Multi-Dimensional Voice Program and Analysis of Dysphonia in Speech and Voice. A measure of accentedness of SAE was calculated using an informal task by two evaluators. Objective acoustic measures of jitter and all-voiced cepstral peak prominence were statistically significant between SAE speakers and L1 Spanish and French speakers. SAE speakers demonstrated significantly higher group mean cepstral peak prominence for the all-voiced sentence ("We were away a year ago.") than native French and Spanish speakers. There were no significant differences in perception of voice quality and acoustic measures secondary to degree of accentedness of the non-native SAE speakers. It is important to engage and strengthen voice diagnostic measures to support culturally competent service delivery for the diversifying clinical population. Normative databases established on SAE speakers should reflect the statistically significant differences evidenced between diverse sociolinguistic populations in anatomical, auditory-perceptual, aerodynamic, and acoustical parameters.

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.

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.

Relation Between Dysphonia Severity Index (DSI) and Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V)

This study aims to conduct a relationship survey between subjective voice assessment (the Persian version of consensus auditory perceptual evaluation of voice (called ATSHA)) and the Dysphonia Severity index (DSI). Cross-sectional, methodological study. Our sample included 144 adults; 48 patients with different voice disorders and 96 volunteers without voice disorders, hearing complaints or any auditory-perceptual voice disorders. The vocal tasks included in the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) and the DSI were performed and recorded. We used subjective and objective assessments to investigate the correlation between the CAPE-V perceptual-auditory assessment parameters and the DSI. Finally, through using the univariate-linear regression and other statistical analyses, we examined the correlation and prediction value of subjective assessment by the DSI. The result of correlation of the total DSI value and individual items with the CAPE-V parameters demonstrated the strongest correlation between the DSI and breathiness (R=0/563) in the second sentence of the CAPE-V scale, and the weakest correlation between the DSI and overall severity (R=0/202) in the sixth sentence. The results of the univariate linear regression model indicated that the highest predictive power was obtained for the DSI and breathiness (R2=0/427) in the sixth sentence in the dysphonic group, while the lowest predictive power was found for low intensity and strain (R2=0/025) in the connected speech in the control group. This study found a significant relationship between the target objective and subjective voice assessment scales in most parameters. Furthermore, the findings of the current study show that the DSI scale, as an objective tool, can predict some auditory-perceptual parameters.

Epidemiological Patterns and Treatment Outcomes in a Private Practice Community Voice Clinic

Voice therapy is administered by speech-language pathologists in multiple practice settings, including private practice community voice clinics. However, the evidence for diagnosis patterns and voice treatment outcomes in community voice clinics is very limited. The purpose of this study was to extend knowledge from a previous investigation by assessing the epidemiological patterns of patient referrals to a private practice community voice clinic across a 4-year period (50 months) and to measure the effectiveness of treatment outcomes for patients who were followed up with voice therapy in the same setting. Retrospective case series. Consecutive patient records from November 2014 through January 2019 were reviewed. Patients were grouped into seven categories of distinctive diagnoses. Descriptive data for each group were extracted to determine epidemiological patterns of disorder diagnosis, voice handicap, voice quality severity, age, and gender. For patients who completed at least three treatment sessions, pre- and posttreatment measurements of two assessments, the Voice Handicap Index (VHI) and the Acoustic Voice Quality Index (AVQI), were extracted and compared using a multivariate analysis of variance. Records from 454 consecutive patient referrals over a 50-month time period were reviewed. The most frequent diagnoses were multifactorial etiologies or those with only a few cases, categorized collectively as an "other" diagnosis category. Diagnoses of nonspecific dysphonia and mid-membranous lesions were also common. Consensus Auditory Perceptual Evaluation of Voice-scale scores were not different among disorders; however, group differences were found for VHI and AVQI. Treatment data were available for 292 patients, with 47 of those patients completing at least three treatment sessions and with data for pre- and posttreatment VHI and AVQI. A mixed multivariate analysis of variance showed a significant effect of treatment (Wilks' Lambda=0.42, F[2]=27.58, P < 0.001, ƞp²=0.58), where both AVQI and VHI improved significantly across the pre- to posttreatment measurements. Patient characteristics and diagnosis patterns across a 50-month period were similar when compared to a previous study that investigated epidemiological patterns in this clinic across 28 months. Voice therapy administered in this community voice clinic to patients with varied diagnoses was found to be effective based on changes in VHI and AVQI measurements.

The Actor's Voice: Vocal Performance Assessment by Different Professionals

The voice production of actors is complex and can be assessed by different professionals. The objective of this study was to measure actor's global vocal performance (GVP) based on overall voice quality (OVQ) and overall severity (OS), by consensus auditory-perceptual evaluation of voice (CAPE-V), and to investigate the possible correlation between these two analyses in actors without self-reported vocal complaints. A total of 39 actors participated in this study, including 20 men and 19 women. Their ages ranged from 18 to 53 years (mean of 33.3 years), with a mean duration of eight years of professional experience. The referred actors were asked to perform predefined CAPE-V tasks and provide one voice sample in which they read a poem at normal loudness; all tasks were recorded. A professional speech-language therapist evaluated the OS based on CAPE-V vocal tasks; scores up to 35.5 mm represented normal parameters, while those from 35.6 to 50.5 mm represented mild deviation, 50.6 to 90.5 mm indicated moderate deviation, and 90.6 to 100 mm indicated severe deviation. A theater director and another speech-language therapist classified the voice samples using the OVQ scale. The OVQ was measured using a 200-mm visual analogue scale. The calculation of terciles allowed the division into three groups regarding the GVP: lowest score group; intermediate score group; and highest score group. The scores of both analyses were compared by sex and groups. Lastly, a correlation analysis was performed between the two analyses for the total sample. There was a significant difference among the three groups and a mild vocal deviation in the lowest score group. In addition, an inversely proportional correlation was observed between GVP and OS. No sex-related differences were observed in the scores for either analyses. The actors without self-reported voice complaints presented differences on GVP scores and their distribution was independent of sex and length of professional experience. Vocal deviation, although mild, on average was greater in actors who had the lowest scores in GVP, with an inversely proportional correlation between these two parameters.

Cepstral Peak Prominence Values for Clinical Voice Evaluation.

PurposeThe goal of this study was to employ frequently used analysis methods and tasks to identify values for cepstral peak prominence (CPP) that can aid clinical voice evaluation. Experiment 1 identified CPP values to distinguish speakers with and without voice disorders. Experiment 2 was an initial attempt to estimate auditory-perceptual ratings of overall dysphonia severity using CPP values.MethodCPP was computed using the Analysis of Dysphonia in Speech and Voice (ADSV) program and Praat. Experiment 1 included recordings from 295 patients with medically diagnosed voice disorders and 50 vocally healthy control speakers. Speakers produced sustained /a/ vowels and the English language Rainbow Passage. CPP cutoff values that best distinguished patient and control speakers were identified. Experiment 2 analyzed recordings from 32 English speakers with varying dysphonia severity and provided preliminary validation of the Experiment 1 cutoffs. Speakers sustained the /a/ vowel and read four sentences from the Consensus Auditory-Perceptual Evaluation of Voice protocol. Trained listeners provided auditory-perceptual ratings of overall dysphonia for the recordings, which were estimated using CPP values in a linear regression model whose performance was evaluated using the coefficient of determination (r 2).ResultsExperiment 1 identified CPP cutoff values of 11.46 dB (ADSV) and 14.45 dB (Praat) for the sustained /a/ vowels and 6.11 dB (ADSV) and 9.33 dB (Praat) for the Rainbow Passage. CPP values below those thresholds indicated the presence of a voice disorder with up to 94.5% accuracy. In Experiment 2, CPP values estimated ratings of overall dysphonia with r 2 values up to .74.ConclusionsThe CPP cutoff values identified in Experiment 1 provide normative reference points for clinical voice evaluation based on sustained /a/ vowels and the Rainbow Passage. Experiment 2 provides an initial predictive framework that can be used to relate CPP values to the auditory perception of overall dysphonia severity based on sustained /a/ vowels and Consensus Auditory-Perceptual Evaluation of Voice sentences.

Factors Associated with Failure of Botulinum Toxin Injection in Adductor Spasmodic Dysphonia.

Electromyography (EMG) Guided botulinum toxin (BTX) injection is considered first-line treatment for adductor spasmodic dysphonia (SD). Failure rate can range between 6% and 29%. Study objective was to determine which factors were associated with failure. This was a retrospective review conducted at a tertiary, academic center. Adductor SD patients presenting for BTX injections from August 2017 to October 2018 were eligible. Age, gender, Voice Handicap Index (VHI-10), Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V), number of injections, disease duration, unilateral/bilateral injection, right/left injection, dose quantity, body mass index (BMI), professional voice user, employment, psychiatric comorbidity, breathiness, and dysphagia were investigated. Outcomes included failure as defined by the patient and dosage change. Univariate and multivariate statistical analysis was conducted. Sixty seven out of 564 injections (12%) were categorized as failure by 131 patients. In multivariate analysis, dosage change was associated with shorter duration of good effect (P < .001), BTX dose (P = .016), breathiness (P < .001), bilateral injection (P = .024), dysphagia (P = .012) and professional voice user (P = .021). Failure was associated with first injection with a new physician (P < .001), professional voice user P < .001) and lack of breathiness (P = .003). Failure rate was not associated with age, gender, VHI-10, CAPE-V, disease duration, left/right injection, dose quantity, BMI, psychiatric comorbidity, and dysphagia. Failure rate was 12% and associated with patients' first injection with a physician, professional voice user, and lack of breathiness. Dosage change occurred in 29% of injections and was associated with injection side effects, bilateral injections, BTX dose, professional voice user, and shorter duration of good effect.Level of evidence: 3.

Outcomes of voice therapy in children with benign vocal fold lesions

ObjectiveThis study aims to examine the effect of voice therapy on dysphonia on children with benign vocal fold lesions, as measured by perceptual evaluation using the Consensus Auditory Perceptual Evaluation of Voice (CAPE-V) and acoustic and aerodynamic measures (jitter, shimmer, noise-to-harmonic ratio, phonation threshold pressure, mean airflow during voicing, subglottic pressure during comfortable phonation). Study designProspective disease-specific outcomes database. MethodsSubjects identified in the database consisted of 28 children (14 male, 14 female) between the ages of three and eighteen. Pre- and post-therapy perceptual, acoustic and aerodynamic measures were compared using two-sided paired t-test. ResultsThere was a statistically significant difference in perceptual ratings of voice quality (p < .001) and in phonation threshold pressure before and after therapy (p = .034). While acoustic measures improved after therapy, changes were not statistically significant. ConclusionsChildren with dysphonia secondary to benign vocal fold lesions showed positive change in perceptual ratings of voice quality and in phonation threshold pressure after voice therapy.

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.

Effects of Fundamental Frequency, Vocal Intensity, Sample Duration, and Vowel Context in Cepstral and Spectral Measures of Dysphonic Voices.

Purpose Smoothed cepstral peak prominence (CPPS) and harmonics-to-noise ratio (HNR) are acoustic measures related to the periodicity, harmonicity, and noise components of an acoustic signal. To date, there is little evidence about the advantages of CPPS over HNR in voice diagnostics. Recent studies indicate that voice fundamental frequency (F0) and intensity (sound pressure level [SPL]), sample duration (DUR), vowel context (speech vs. sustained phonation), and syllable stress (SS) may influence CPPS and HNR results. The scope of this work was to investigate the effects of voice F0 and SPL, DUR, SS, and token on CPPS and HNR in dysphonic voices. Method In this retrospective study, 27 Brazilian Portuguese speakers with voice disorders were investigated. Recordings of sustained vowels (SVs) /a:/ and manually extracted vowels (EVs) /a/ from Consensus Auditory-Perceptual Evaluation of Voice sentences were acoustically analyzed with the Praat program. Results There was a highly significant effect of F0, SPL, and DUR on both CPPS and HNR (p < .001), whereas SS and vowel context significantly affected CPPS only (p < .05). Higher SPL, F0, and lower DUR were related to higher CPPS and HNR. SVs moderately-to-highly correlated with EVs for CPPS, whereas HNR had few and moderate correlations. In addition, CPPS and HNR highly correlated in SVs and seven EVs (p < .05). Conclusion Speaking prosodic variations of F0, SPL, and DUR influenced both CPPS and HNR measures and led to acoustic differences between sustained and excised vowels, especially in CPPS. Vowel context, prosodic factors, and token type should be controlled for in clinical acoustic voice assessment.

Reliability and Validity of the Kannada Version of the Consensus Auditory-Perceptual Evaluation of Voice.

Purpose The purpose of this study was to evaluate the reliability and validity of the Kannada version of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V). Method The Kannada version of CAPE-V comprises six phrases that are phonetically designed as per the CAPE-V requirements. Sixty-five (21 individuals with dysphonia and 44 asymptomatic) participants were enrolled for the instrument psychometric validation. The interrater and intrarater reliability as well as validity were assessed. Results High level of agreement was noted between the three raters across all the CAPE-V parameters, highest for pitch (intraclass correlation coefficient value = .98) and lowest for loudness (intraclass correlation coefficient value = .96). High intrarater reliability agreement (intraclass correlation coefficient value > .97) was also noted for all the parameters. Among the correlation for parameters that are comparable between CAPE-V and the Grade, Roughness, Breathiness, Asthenia, and Strain scale, the highest correlation was noted for overall severity. There was a significant difference noted between the study and control groups for all parameters except loudness. The discriminant function analysis and classification revealed that 98% were correctly identified. Conclusion The Kannada version of CAPE-V has been proven to be a psychometrically reliable and valid tool to use for auditory-perceptual evaluation of voice.

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.

Characteristics of the Voice of Dysphonic School Children from 4:0 to 7:11 Years Old

Childhood dysphonia is frequent and has many origins, with the most common initial symptom being the altered vocal quality. Describe and correlate the auditory-perceptual and acoustic characteristics of the voice, and the maximum phonation time (MPT), of dysphonic schoolchildren from private and public schools from 4:0 to 7:11 years old, female and male. MPT, acoustic (Multi-Dimensional Voice Program Advanced and Real Time Spectrogram), and auditory-perceptual (Consensus Auditory-Perceptual Evaluation of Voice) evaluations of 115 schoolchildren were statistically analyzed. Auditory-perceptual parameters values were classified as mild, and MPT values were reduced, in most children. Fundamental frequency and Jitt values decreased significantly with age; MPT/i/ increased significantly with age. Relative average perturbation, voice turbulence index (VTI), and number of sub-harmonic segments values were significantly higher in 4:0 years old children. The number of unvoiced segments was higher in 6:0 years old children. Shimmer percent was higher in 7:0 years old children. There were negative correlations between the high frequency spectrographic tracing color intensity and the vocal strain; the VTI and the MPT; the degree of unvoiced segments and the MPT. There was a positive correlation between the smoothed pitch period perturbation quotient and the roughness. In dysphonic schoolchildren, auditory-perceptual parameters were moderate, MPT was reduced, several acoustic parameters were altered, and these vocal characteristics improved with age.

An evaluation of Short-term Treatment Outcomes of Cricothyroid Visor Maneuver: A Proof-of-Concept Pilot Study

Muscle tension dysphonia (MTD) is used as a clinical and diagnostic descriptive label for a diverse range of vocal fold behaviors caused by increased tension of the (para) laryngeal musculature. These increased tension can occur in the cricothyroid muscle and in the ''visor'' mechanism, contributing to voice problems. The main goal of this study is to determine whether a new method, the cricothyroid visor maneuver (CVM), is an effective method for improving quality and other aspects of the MTD patients' voices. Eighty-eight adult female patients participated in this quasiexperimental study. One group consisted of 30 MTD patients (mean age 28.7 ± 4.95 years) for whom manual circumlaryngeal therapy (MCT) was provided. The other group consisted of 30 MTD patients (mean age 28.9 ± 5.1 years) who received CVM. Also, 28 adult females with MTD (mean age 28.60 ± 4.56 years), who were on the clinic's waiting list, served as a control group and did not receive any treatment. Treatment was provided in a single 30-minute session. Pre- and post-treatment audio recordings of sustained vowels, selected sentences, and connected speech samples were submitted to auditory-perceptual and acoustical analysis to assess the short-term effects of the two treatment programs. Also, perceptions of patients' about their voice quality before and after therapy were assessed by visual analogue scale. Perceptually, Consensus Auditory Perceptual Evaluation of Voice (CAPE-V) ratings improved in all patients with both treatment methods. Acoustically, with CVM, harmonic-to-noise ratio and Cepstral Peak Prominence increased and perturbation (jitter and shimmer) measures decreased and there was not significant change in MCT and control groups. Visual analogue scale showed that feelings of patients improved after therapy in both treatment methods, with higher scores for patients receiving CVM in comparison to the MCT method. These results suggest that CVM can be an effective method for voice rehabilitation in patients with MTD and manipulation of Cricothyroid muscle and ''visor'' mechanism can lead to marked voice improvement.