Dysphonia Severity Index Scores Research Articles

Voice quality in patients with temporomandibular disorders

ABSTRACT Objectives This study assessed the voice quality in TMD patients compared to healthy individuals using the Dysphonia Severity Index (DSI) and evaluated the correlation between the DSI and TMD severity. Methods Patients who had TMD with Fonseca’s anamnestic index were subjected to an examination based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). A sample of 35 patients with TMD and 36 healthy subjects were included in the study. Results There were significant differences in the DSI score and its components between healthy subjects and TMD patients (p < .001). A significant correlation was found between the DSI scores and TMD severity (Spearman’s rho: −0.90, p < .001). Conclusion Patients with TMD demonstrated lower DSI scores and lower voice quality compared to healthy subjects.

Optimizing Deep Brain Stimulation in Essential Tremor: A Randomized Controlled Trial for Target Consideration.

The thalamic ventral intermediate nucleus (VIM) is a well-established target for deep brain stimulation (DBS) in the treatment of essential tremor (ET). Increasing data indicate that the posterior subthalamic area (PSA) may be superior, but high-level evidence is limited. We aimed at further comparing the intraindividual efficacy and side effect profile of PSA vs VIM DBS in ET. In this randomized, double-blind, crossover trial, 4-contact DBS leads were bilaterally implanted with single-trajectory covering the VIM and PSA. Patients were randomized postsurgery to 2 groups, receiving VIM stimulation (4-7 months) and then PSA stimulation (8-11 months) or vice versa. The primary end point was the difference in improvement from baseline to the end of the VIM vs PSA DBS period in the total score of the Fahn-Tolosa-Marin Tremor Rating Scale (FTM-TRS). Ten patients with medically refractory ET were enrolled, and 9 completed the study. The difference between reduction of FTM-TRS total score in the PSA vs VIM DBS period was -7.4 (95% CI: -28.5 to 13.7, P = .328). Clinical benefit was achieved at significantly lower stimulation intensity under PSA DBS. Furthermore, PSA DBS provided greater improvement in head tremor subscore of FTM-TRS (PSA vs VIM: -2.2, P = .020) and disease-specific quality of life (PSA vs VIM: -13.8, P = .046) and induced fewer speech (Dysphonia Severity Index score: P = .043; diadochokinetic rate: P = .007; VDI score: P = .005) and gait disturbances compared with VIM DBS. Seven patients remained with PSA DBS after the crossover phase. Our study confirms that PSA-DBS is comparable with VIM-DBS in suppressing tremors, superior in improving disease-specific quality of life, and possibly more effective in reducing head tremor.

Acupuncture Combined with Voice Training Improved Voice Function in Patients with Primary Muscular Tension Dysphonia (MTD): A Randomized, Three-Armed, Open-Label Clinical Trial

Objective. This randomized controlled trial aimed to evaluate the clinical efficacy of acupuncture combined with voice training for treating patients with primary muscular tension dysphonia (MTD) (Qi stagnation and blood stasis type in traditional Chinese medicine). Methods. A total of 108 patients with primary MTD (Qi stagnation and blood stasis type) were recruited in this study. The participants were randomly divided into 3 equal groups: a test group and two control groups (control groups 1 and 2). An additional 38 participants without primary MTD were recruited as the healthy group. Control group 1 received acupuncture sessions 3 times per week on alternate days on the Hegu (LI 4), Taichong (LR 3), Open Voice No. 1 point, and Open Voice No. 2 points. Control group 2 received a 40-minute voice training session once weekly. The test group received both treatments. The total treatment course for all groups was 30 days. The healthy participants did not receive any interventions. The physiological and functional voice improvements after treatment were compared between all 3 MTD groups and healthy participants. The Voice Handicap Index (VHI-10), the VHI-10 emotional score, the Chinese Medicine Symptom Score Scale (TCM), and the Grade Roughness Breathiness Asthenia Strain (GRBAS) were used to evaluate the changes in the voice after treatment. A laryngeal muscle blood oxygen monitoring was used to measure the blood oxygen saturation (SO2) of the suprahyoid and infrahyoid muscles, and a stroboscopic laryngoscopy was used to measure the dysphonia severity index (DSI). Acoustic voice analysis was used to measure the maximum phonation time (MPT), the jitter, and the shimmer. Result. The SO2 levels of the laryngeal muscle were significantly higher in the healthy subjects than in pretreatment MTD patients and were correlated with the VHI-10 and DSI scores. A significant improvement in the physiological and functional scores, the total VHI-10, the GRBAS score, the voice acoustic analysis indices, MPT, jitter, shimmer, and DSI, was noted after treatment in all 3 MTD groups ( P &lt; 0.05 ). However, the posttreatment scores in the test group were significantly higher compared to control group 2, whose score were superior than that in control group 1 ( P &lt; 0.05 ). Both the test group and control group 1 showed a significant increase in the SO2 levels of the laryngeal muscles after treatment, where the test group had a higher elevation than control group 1. No significant difference was noted in the posttreatment SO2 of the laryngeal muscles in control group 2 ( P &gt; 0.05 ). Conclusion. Acupuncture monotherapy or in combination with voice training can reduce the anxiety emotion, relieve MTD-associated systemic symptoms, and increase the SO2 levels of the laryngeal muscle. This combination is a promising approach for the treatment of MTD. This trial is registered with ChiCTR2200061469.

Voice Outcome of Glottoplasty in Trans Women

This study investigates the short- and longer-term effects of glottoplasty up to six months after surgery on acoustic voice parameters, listener perceptions, and client's satisfaction in trans women. Secondly, the impact of chondrolaryngoplasty and voice therapy on the glottopasty outcomes was investigated. A prospective longitudinal non-controlled trial was used. Thirty-five trans women undergoing glottoplasty or a combination of glottopasty and chondrolaryngoplasty were included in this study. A voice assessment was conducted before surgery and 1 week, 1 month and 6 months after surgery. The following outcome parameters were measured: fundamental frequency (fo), intensity, frequency and intensity range, Dysphonia Severity Index (DSI), Acoustic Voice Quality Index (AVQI), Voice Handicap Index (VHI), Trans Woman Voice Questionnaire (TWVQ), and visual analogue scales (VAS) measuring client's satisfaction. Listener perceptions of masculinity-femininity were collected using a listening experiment. Significant differences over time were found for all fo and intensity parameters, DSI, AVQI, VHI and TWVQ scores. Listener perception and self-perception of femininity was higher after surgery. Significant differences in evolution of listener perceptions were found between the groups with and without voice therapy. Glottoplasty improves voice related quality of life and is an effective method to increase the fo and associated perceptual femininity. After glottoplasty an immediate and short-term decrease in voice quality, vocal capacity and frequency range was measured with a progressive recovery on the longer term. Long term side effects of glottoplasty are a reduction in speaking intensity and intensity range. Voice therapy seems to improve the outcomes of glottoplasty, but should be further investigated in future studies.

Accuracy Analysis of the Multiparametric Acoustic Indices AVQI, ABI, and DSI for Speech-Language Pathologist Decision-Making

To investigate the accuracy of the Acoustic Voice Quality Index (AVQI), the Acoustic Breathiness Index (ABI), and the Dysphonia Severity Index (DSI) for speech-language pathologist (SLP) decision-making in the evaluation of teachers' voice conditions. Cross-sectional observational study with a convenience sample composed of 21 teachers "fit" in carrying out their work activities as a teacher, and 21 considered "unfit" for the same. All teachers underwent a voice evaluation, carried out by a voice-specialized speech-language pathologist. Voice evaluation included the SLP's opinion on whether the teachers presented "fit" or "unfit" for work. The voice and speech samples used for the AVQI and ABI scores were the mid-three seconds of a sustained vowel /a/, and a spontaneous count from 1 to 10. The following parameters were used to extract the DSI score: mid-three seconds of a sustained vowel /a/, maximum phonation time of a sustained vowel /a/, ascending vocal glide on the vowel /a/ until reaching the highest pitch, and sustained vowel /a/ at the softest possible vocal intensity. The t-test was used to compare the difference between the AVQI and ABI indices. The Mann-Whitney test was used for the DSI index, with a confidence level of 95%. The receiver operating characteristic curve (ROC) was used for accuracy analysis. There was a difference in AVQI values (P=0.008), ABI (P=0.014), and DSI (P=0.000) between groups. The cutoff points that revealed the highest specificity for the AVQI, ABI, and DSI respectively were 3.33 (sensitivity 57.1% and specificity 90.5%), 4 (sensitivity 57.1% and specificity 85.7%), and 1.62 (sensitivity 71.4% and specificity 90.5%). The AVQI, ABI, and DSI are instruments that provide robust voice information and can help speech-language pathologists in their decision-making about whether teachers must or must not be restricted in their vocal activities at work.

Investigating the Relationship Between the Dysphonia Severity Index and the Speech and Voice Severity of Parkinson Disease Patients

Objectives: This study aims to investigate the relationship between dysphonia severity index (DSI), speech disease and voice severity of Parkinson disease (PD) patients. Methods: This was a cross-sectional study, carried out on 45 randomly selected PD patients with the age range of 50 to 75 years. The Hoehn and Yahr scale (H.Y scale) was employed to measure the severity of PD. To measure the DSI, we required detecting the acoustic features of the voice, such as shimmer (dB), vital capacity (VC), semitone range (STR), and voice onset time (VOT); therefore, the participants were asked to produce the vowel /a/ three times for calculating the variables, i.e., STR, VOT, fundamental frequency (F0), second formant (F2), and shimmer (dB). Their voices were analyzed by the Praat software (version 6.0.23). F0 and F2 were utilized to calculate the STR. The VOT was assessed by analyzing the spectrograph of the syllable /pa/. The Kruskal-Wallis test was used to understand the correlation between DSI scores and the stage of PD (Y.H scale); the P value of less than 0.05 was considered significant. Results: A significant relationship was detected between severe DSI and the stage of PD. Meanwhile, the DSI score was statistically significant compared to the scores of the other four groups (P&lt;0.05). Discussion: There was a significant relationship between the severity of voice changes in PD patients by DSI and the stage of their disease. Further studies in this field are needed considering that such information may be of cardinal importance for voice professionals to take early interventions, appropriate to the stage of PD.

Vocal habits, dysphonia severity index, and voice-related quality of life in indian primary school teachers: An exploratory study

Context: Only a handful of studies have explored the relationship between vocal habits, Dysphonia Severity Index (DSI) scores, and Voice-Related Quality of Life (VRQOL), especially among Indian primary school teachers. Aims: We aimed to document the factors affecting DSI and VRQOL scores among Indian primary school teachers and to study the correlation between these measures in Indian teachers with and without dysphonia. Settings and Design: This was a retrospective standard group comparison study. Subjects and Methods: A total of 90 primary school teachers (33 males and 57 females) were administered a vocal health questionnaire, and based on the questionnaire responses, participants were classified into two groups. Group 1 consisted of 33 participants without any self-reported symptoms of voice problems. Group 2 included 57 participants with self-reported symptoms of voice problems. Further, the phonation samples were recorded, and DSI scores were calculated. Participants were also instructed to fill out the VRQOL questionnaire. Statistical Analysis Used: Shapiro-Wilk test, the Mann-Whitney U-test, and Spearman's rank correlation coefficient were carried out as a part of statistical analyses. Results: Teachers with self-reported vocal symptoms exhibited more frequent habits such as consumption of beverages, intake of spicy and oily food, less time interval between intake of meals and sleep, coughing, speaking at uncomfortable volumes, and frequent screaming or yelling or cheering. There was a significant positive correlation between VRQOL and the DSI values. Conclusion: Future studies can be carried out to discern the impact of the classroom's size, population, background noise, and amplification equipment on teachers.

Assessment of Voice Changes of Patients after Thyroidectomy Without Inferior and Superior Laryngeal Nerves Injury According to the Intraoperative Neuromonitoring

Objectives: to assess voice changes of patients after thyroidectomy without inferior and superior laryngeal nerves injury according to the intraoperative neuromonitoring. Material and methods: This monocentric study included all patients who underwent thyroidectomy with laryngeal nerves neuromonitoring between September, 2018 and December, 2019. The voice assessment was performed 1 month before and 3 months after surgery. It was both subjective (with Voice Handicap Index 10 and GRBAS scale) and objective (Dysphonia Severity Index). Voice was considered impaired if there was an increase ≥ 4 points of the Voice Handicap Index 10 score or ≥ 1 point of the GRBAS scale score or a decrease ≥ 2 points of the Dysphonia Severity Index score between the two vocal assessments. A composite score was created, combining both subjective and objective scores. Predictive factors of altered voice were seek. Results: Fifty-nine patients were analyzed. Mean Voice Handicap Index 10 varied from 3.39 ± 5.40 to 2.90 ± 5.29 (p = 0.62) before and after the surgery respectively, mean GRBAS from 0.64 ± 0.76 to 0.73 ± 0.85 (p = 0.57) and mean Dysphonia Severity Index from 8.47 ± 1.15 to 8.31 ± 1.03 (p = 0.42). Voice impairment composite score identified 14 patients with an impaired voice (23.7%). Age ≥65 years, preoperative Voice Handicap Index 10 score ≥ 3 and thyroidectomy past history were independent risk factors of voice impairment. Conclusions: the voice quality 3 months after thyroidectomy was not significantly subjectively and objectively changed compared to before thyroidectomy. When grouping voice impairment scores, age ≥65 years, preoperative Voice Handicap Index 10 score ≥ 3 and thyroidectomy past history were independent risk factors of voice impairment.

Structure and Function of the Vocal Cords after Airway Reconstruction on Magnetic Resonance Imaging.

Objectives/HypothesisDysphonia is a common problem at long‐term follow‐up after airway surgery for laryngotracheal stenosis (LTS) with major impact on quality of life. Dysphonia after LTS can be caused by scar tissue from initial stenosis along with anatomical alterations after surgery. There is need for a modality to noninvasively image structure and function of the reconstructed upper airways including the vocal cords to assess voice outcome and possible treatment after LTS. Our objective was to correlate vocal cord structure and function of patients after airway reconstruction for LTS on static and dynamic magnetic resonance imaging (MRI) to voice outcome.Study DesignProspective cohort study.MethodsVoice outcome was assessed by voice questionnaires ((pediatric) Voice Handicap Index (p)VHI)) and the Dysphonia Severity Index (DSI). Postsurgical anatomy, airway lumen, and vocal cord thickness and movement on multiplanar static high‐resolution MRI and dynamic acquisitions during phonation was correlated to voice outcome.ResultsForty‐eight patients (age 14.4 (range 7.5–30.7) years) and 11 healthy volunteers (15.9 (8.2–28.8) years) were included. Static MRI demonstrated vocal cord thickening in 80.9% of patients, correlated to a decrease in DSI (expected odds 0.75 [C.I. 0.58–0.96] P = .02). Dynamic MRI showed impaired vocal cord adduction during phonation in 61.7% of patients, associated with a lower DSI score (0.65 [C.I. 0.48–0.88] P = .006).ConclusionsIn LTS patients, after airway reconstruction MRI can safely provide excellent structural and functional detail of the vocal cords correlating to DSI, with further usefulness expected from technical refinements. We therefore suggest MRI as a tool for extensive imaging during LTS follow‐up.Level of evidence3 Laryngoscope, 131:E2402–E2408, 2021

Effect of Muscle Tension Dysphonia on Self-perceived Voice Handicap and Multiparametric Measurement and Their Relation in Female Teachers

Muscle tension dysphonia (MTD) is a common voice disorder in teachers in which subjective and objective dimensions of quality of voice can be impaired. The study aimed to compare voice handicap index (VHI) and dysphonia severity index (DSI) in teachers with and without MTD as well as study correlation between them. Cross-sectional survey. Fifty female teachers were enrolled in the study in two different groups (1) twenty-five teachers with MTD (with mean age of 42.62 ± 3.58 years) and (2) 25 teachers without MTD (with mean age of 44.50 ± 3.49 years). All participants completed the Persian version of VHI and underwent multiparametric measurement of voice by the DSI; these subjective and objective voice measures were compared between two groups and their relation was studied. There was significant difference in the VHI, DSI, and their components in teachers with and without MTD (P < 0.05). No significant correlation was found between the total score of VHI and DSI score in the teachers with MTD (rPearson: 0.04, p: 0.82), although there was significant correlation between them in the teachers without MTD (rPearson: -0.75, p: 0.001). Teachers with MTD demonstrated higher voice handicap and lower voice quality compared to the teachers without MTD. Moreover, dysphonia interrupted relation between the results of self-perceived evaluation and multiparametric measurement of voice in the teachers with MTD in while these assessments were parallel in the healthy teachers. Further studies are recommended to transparent relation between objective and subjective voice assessments in healthy population.

Comparison of Dysphonia Severity Index and its Parameters Among Individuals with Multiple Sclerosis and Healthy Subjects

Background: Concerning demyelination’s process in multiple sclerosis (MS), speech changes often occur earlier than other symptoms; thus early diagnosis of these changes is necessary. According to recent studies, phonation subsystem appears with the most symptoms compared with other subsystems, especially in the initial stages. In this study, the researchers aimed at comparing these symptoms in MS patients with healthy people using dysphonia severity index (DSI) and its parameters. Methods: This study was conducted on 40 MS patients and 20 healthy individuals in Ahvaz city. The subjects were asked to phonate vowel /a/ for calculating maximum phonation time (MPT), maximum F0, jitter, minimum intensity, and DSI score with the Praat software. For statistical analysis of data, Kolmogorov-Smirnov and independent t-test were used. Results: The mean scores of DSI in MS patients (1.07 ± 1.51) was significantly lower than the control group (3.603 ± 1.13) (P value < 0.001). Maximum phonation time and maximum frequency values in MS patients were lower than the control group (MPT, P value = 0.005; maxF0, P value = 0.003). Jitter and minimum intensity values in MS patients were higher than the control group (jitterppq5, P value < 0.001; min intensity, P value = 0.040). Conclusions: The findings of this study indicated that the MS group had worse vocal quality than the healthy group, which means they were at risk of voice and speech problems; therefore, acoustic assessments can determine the vocal impairments of the disease at the early stages and prevent progression of vocal impairments with an appropriate treatment plan. Also, dysphonia severity index, as a reliable tool, can detect vocal quality impairments in multiple sclerosis and can be a supplementary assessment tool for early detection of degenerative diseases.

Voice outcome and voice-related quality of life after surgery for pediatric laryngotracheal stenosis.

To evaluate the long-term outcome of voice quality and voice-related quality of life after open airway surgery for pediatric laryngotracheal stenosis. Prospective cohort study. Children under the age of 18 years at time of follow-up and with a history of open airway surgery for acquired laryngotracheal stenosis were included in this analysis. To assess voice-related quality of life, the pediatric voice handicap (pVHI) index was completed by the patients' parents. The dysphonia severity index (DSI) was used as an objective measurement for voice quality. Fifty-five parents completed the pVHI, and 38 children completed the DSI. This showed high pVHI values and low total DSI scores, indicating significant voice disturbance. After multivariate analysis, the presence of comorbidities and glottic involvement of the stenosis are associated with poor long-term voice-related quality of life. Significant voice disturbance is common after surgery for pediatric laryngotracheal stenosis. Glottic involvement of the stenosis and comorbidities is associated with poor voice-related quality of life. Evaluation of pre- and postoperative voice quality and voice-related quality of life is advised for children treated for laryngotracheal stenosis. 2B. Laryngoscope, 127:1707-1711, 2017.

Factors Involved in Vocal Fatigue: A Pilot Study

Objective: The purpose of this retrospective study was to determine the vocal characteristics of a treatment-seeking population with the primary complaint of vocal fatigue (VF). Methods: Forty-three men (mean age 42 years, range 19-69) and 145 women (mean age 34 years, range 18-68) were included. None of the subjects had received voice therapy or previous laryngeal surgery. A questionnaire, laryngeal and perceptual evaluations, aerodynamic and acoustic parameters, and the Dysphonia Severity Index (DSI) were used to determine vocal characteristics. Results: In 74% of the subjects, flexible laryngeal videostroboscopic evaluation revealed a vocal pathology, with vocal nodules and muscle tension dysphonia as the most frequently diagnosed pathologies. Vocal abuse/misuse was present in 65% of the subjects. A median DSI value of -0.4 and -0.8 was found in female and male patients, respectively. Aerodynamic and acoustic parameters and DSI scores were significantly different from normative data. Conclusion: VF is a vocal sign with a significant need for medical consultation, especially in future professional voice users. Understanding the occurrence and the influencing variables of VF may help to close the gap between early stages of a vocal problem and the starting point of a well-established disorder.

Dysphonia Severity Index in Typically Developing Indian Children

Dysphonia is a variation in an individual's quality, pitch, or loudness from the voice characteristics typical of a speaker of similar age, gender, cultural background, and geographic location. Dysphonia Severity Index (DSI) is a recognized assessment tool based on a weighted combination of maximum phonation time, highest frequency, lowest intensity, and jitter (%) of an individual. Although dysphonia in adults is accurately evaluated using DSI, standard reference values for school-age children have not been studied. This study aims to document the DSI scores in typically developing children (8-12 years). A total of 42 typically developing children (8-12 years) without complaint of voice problem on the day of testing participated in the study. DSI was computed by substituting the raw scores of substituent parameters: maximum phonation time, highest frequency, lowest intensity, and jitter% using various modules of CSL 4500 software. The average DSI values obtained in children were 2.9 (1.23) and 3.8 (1.29) for males and females, respectively. DSI values are found to be significantly higher (P = 0.027) for females than those for males in Indian children. This could be attributed to the anatomical and behavioral differences among females and males. Further, pubertal changes set in earlier for females approximating an adult-like physiology, thereby leading to higher DSI values in them. The mean DSI value obtained for male and female Indian children can be used as a preliminary reference data against which the DSI values of school-age children with dysphonia can be compared.

The Effect of Smoking on the Dysphonia Severity Index in Females

Objective: This study investigated the capability of the Dysphonia Severity Index (DSI) and its component measures to reveal differences in vocal capability between groups of young adult female smokers and nonsmokers. Patients and Methods: The subjects were 30 female nonsmokers and 30 female smokers between the ages of 18 and 24 years. Data on the DSI components (maximum phonation time, MPT; highest phonational frequency, F_{0 high}; lowest intensity, I_low, and jitter) were collected, followed by calculation of the DSI. Results: Significant differences between groups were observed on the DSI, with reduced DSI scores in smokers primarily due to reductions in F_{0 high} and increases in I_low. A strong partial correlation between MPT and the DSI in smokers may be indicative of reductions in respiratory support and/or phonatory control. Conclusions: Significant group differences in the DSI and component measures may be indicative of early changes in vocal function secondary to smoking. Reductions in frequency and dynamic range are consistent with the possibility of increased vocal fold mass in smokers. The results indicate that significant differences in the DSI between groups may be observed in subjects with perceptually normal vocal quality and with normal levels of vocal perturbation.

A Comparison of Trained and Untrained Vocalists on the Dysphonia Severity Index

The purposes of this study were (1) to compare trained and untrained singers on the Dysphonia Severity Index (DSI) and its component measures, and (2) to contribute to normative DSI data for trained singers. This study included 36 untrained participants (15 males and 21 females) and 30 participants (15 males and 15 females) with singing experience between the ages of 18 and 30 years. Measures of maximum phonation time (MPT), highest phonational frequency, lowest intensity, and jitter were obtained for each subject and incorporated into the previously published multivariate DSI formula. Results indicated that vocally trained subjects have significantly higher DSI scores than untrained subjects (mean DSI: 6.48 vs 4.00, respectively), with significant differences observed between trained and untrained groups for three of the four components of the DSI (F(0) high; I low; jitter). The findings of this study are consistent with previous reports that indicate significant increases in the DSI with vocal training, and with various studies that have observed increased vocal capability in trained singers versus their untrained counterparts. The results of this study indicate that alternative normative expectations for the DSI may need to be taken into account when using the DSI with patients who have participated in directed vocal training, such as choral participation and voice/singing lessons.

The Applicability of the Dysphonia Severity Index and the Voice Handicap Index in Evaluating Effects of Voice Therapy and Phonosurgery

The objective was to investigate the applicability of the Dysphonia Severity Index (DSI) and the Voice Handicap Index (VHI) in evaluating effects of intervention between groups of patients and for intrasubject differences and whether DSI and VHI are complementing measurements. Analyses of measurement data before and after intervention of 171 patients with voice disorders. The voice quality was measured objectively with the DSI. The perceived voice handicap was measured with the VHI. Three groups of patients were used: patients who had voice therapy, phonosurgery, or no intervention. DSI and VHI improved significantly after intervention in the voice therapy and the surgery group (median difference DSI 1.19 and 3.03, VHI -8 and -26, respectively). The intrasubject results were analyzed based on the test-retest variability of DSI and VHI. Significant better DSI and VHI scores after intervention were found in, respectively, 22% and 38% of the patients with voice therapy, and 56% and 78% of the patients with surgery. In the no intervention group, this was 11% and 12%. In 37% of the patients, the differences before and after intervention in DSI and VHI were in discordance. The DSI and VHI are able to show significant differences after intervention for voice disorders between groups of patients. The DSI and VHI can be used to determine a significant intrasubject result of intervention. The DSI and VHI measure each different aspects of the voice and are complementing measurements. The DSI is therefore applicable in clinical practice for objective evaluation of voice quality and the VHI for subjective evaluation of the perceived handicap by the patient self.

Does an Exercise Aimed at Improving Swallow Function Have an Effect on Vocal Function in the Healthy Elderly?

Age-related sarcopenia or muscle wasting contributes to changes in the ability to perform activities of daily living, changes in deglutition, and changes in vocal function. The Shaker Exercise, an isometric and isokinetic exercise, has been shown to strengthen suprahyoid muscles and increase deglutitive anteroposterior (AP) upper esophageal sphincter (UES) opening diameter. The aim of this study was to determine if this exercise has an effect on the age-related changes in vocal function and deglutition in healthy older adults. Eleven females and 10 males, aged 65-78 years (mean = 70 +/- 4 years) and with a negative history for dysphagia and voice disorders, participated by exercising three times per day for 6 weeks. Five age-matched controls did not perform the exercise. Acoustic analysis of voice and biomechanical analysis of deglutition were performed before and after 6 weeks of exercise. Controls participated in voice analysis only. Dysphonia Severity Index (DSI), a multivariate voice index, was used to compare voice production initially and after 6 weeks. Deglutitive biomechanical measures increased and DSI scores improved in 10 of 21 participants following 6 weeks of the exercise. DSI for controls did not change over the 6-week period. Ten of 21 exercise participants experienced improved deglutitive biomechanics and DSI scores. Accuracy of exercise performance, compliance, and/or disclosed alterations in health status may contribute to the lack of deglutitive and DSI change in the participants who did not experience change in function. A large randomized control study, including periodic monitoring of health status, exercise performance accuracy, and compliance, is warranted to evaluate the affect of this exercise on deglutition as well as voice. The Shaker Exercise could be recommended as a preventative measure to diminish the effect of sarcopenia on the muscles used in deglutition and voice and alter the progression of the characteristic senescent voice and swallow changes.

The Relationship Between Perceptual Evaluation and Objective Multiparametric Evaluation of Dysphonia Severity

The purpose of this study was to investigate the usefulness of the Dysphonia Severity Index (DSI) as an objective multiparametric measurement in assessing dysphonia. The DSI was compared with the score on Grade of the GRBAS scale. Investigated was also whether the DSI is related to severity of dysphonia, which was represented by different diagnosis groups. Furthermore, it was investigated whether the DSI can differentiate between a group of patients and a control group. A total of 294 patients with different voice pathologies were included. A control group consisted of 118 volunteers without any voice complaints. The voices of all participants were perceptually evaluated on Grade, and the DSI was measured. The groups of patients with voice complaints have a lower DSI and higher scores on Grade than the control group. The DSI was significantly lower when the score on Grade was higher. The DSI discriminates between patients with nonorganic voice disorders, vocal fold mass lesions, and vocal fold paresis/paralysis. To determine whether the DSI discriminates between patients and controls, the sensitivity and specificity for different DSI cutoff points were calculated. With a DSI cutoff of 3.0, maximum sensitivity (0.72) and specificity (0.75) were found. We conclude that the DSI is a useful instrument to objectively measure the severity of dysphonia.

Muscular Tension and Body Posture in Relation to Voice Handicap and Voice Quality in Teachers with Persistent Voice Complaints

The aim of this study was to investigate the relationship between extrinsic laryngeal muscular hypertonicity and deviant body posture on the one hand and voice handicap and voice quality on the other hand in teachers with persistent voice complaints and a history of voice-related absenteeism. The study group consisted of 25 female teachers. A voice therapist assessed extrinsic laryngeal muscular tension and a physical therapist assessed body posture. The assessed parameters were clustered in categories. The parameters in the different categories represent the same function. Further a tension/posture index was created, which is the summation of the different parameters. The different parameters and the index were related to the Voice Handicap Index (VHI) and the Dysphonia Severity Index (DSI). The scores of the VHI and the individual parameters differ significantly except for the posterior weight bearing and tension of the sternocleidomastoid muscle. There was also a significant difference between the individual parameters and the DSI, except for tension of the cricothyroid muscle and posterior weight bearing. The score of the tension/posture index correlates significantly with both the VHI and the DSI. In a linear regression analysis, the combination of hypertonicity of the sternocleidomastoid, the geniohyoid muscles and posterior weight bearing is the most important predictor for a high voice handicap. The combination of hypertonicity of the geniohyoid muscle, posterior weight bearing, high position of the hyoid bone, hypertonicity of the cricothyroid muscle and anteroposition of the head is the most important predictor for a low DSI score. The results of this study show the higher the score of the index, the higher the score of the voice handicap and the worse the voice quality is. Moreover, the results are indicative for the importance of assessment of muscular tension and body posture in the diagnosis of voice disorders.