Dysphonia Severity Index Research Articles

The Impact of a Teaching or Singing Career on the Female Vocal Quality at the Mean Age of 67 Years: A Pilot Study

The purpose of this study was to measure the objective and subjective vocal quality in women aged between 60 and 75 years. Secondly, the impact of a teaching or singing career on the vocal quality was investigated by comparing the vocal quality of retired women with different careers. This is a case-control study. Seventy-three retired women between 60 and 75 years (mean age: 67 years, standard deviation: 4.49) participated in the study and were divided into three groups: women with a teaching career (n = 21), choir singers with a singing career (n = 12), and women with a non-vocal career (n = 40). All subjects underwent the same assessment protocol consisting of objective (aerodynamic, maximum performance, vocal range, acoustic measurements, and the Dysphonia Severity Index) and subjective (the Voice Handicap Index, auditory-perceptual evaluations by three listeners) voice measurements. In all three groups, objective and perceptual voice analysis showed a mild dysphonia. No differences in the Dysphonia Severity Index were found between the three groups. The voices of choir singers with a singing career were perceived significantly less rough than voices of the women with a non-vocal career. Additionally, the lowest frequency of the frequency range was significantly lower in the retired teachers and choir singers than in the controls. The results of this study prudently suggest that a singing or a teaching career compared with a non-vocal career has a positive impact on the vocal frequency range, and that singing has a positive impact on the perceptual vocal quality of the older female voice.

Vocal Characteristics and Laryngoscopic Findings in Future Musical Theater Performers

Musical theater performers are a special group of elite vocal performers with a high vocal load as they combine singing, acting, and physical performance. As they are absolutely depending on their voice quality and vocal capacities for their studies and their future profession, an optimal voice production is very important. The purpose of this study was to determine the voice quality of musical theater students. The voice quality of seven students was then reevaluated 1 year after the first assessment. Observational study. Thirty-one musical students (7 men and 24 women) with a mean age of 20 years participated in the study. To determine the voice quality, objective (aerodynamic measurements, voice range profile, acoustic analysis, and Dysphonia Severity Index) and subjective (videolaryngostroboscopy, Voice Handicap Indexes, and questionnaires regarding voice symptoms and risk factors) voice measurements were performed. The median Dysphonia Severity Index in male and female musical students was respectively 5.3 and 5.7, both corresponding with an overall good voice quality. The questionnaires revealed the presence of vocal fatigue, dryness of the throat, vocal tract discomfort, and harmful vocal habits in the majority of students. In 45% of the subjects, videolaryngostroboscopic evaluation of the vocal folds showed an organic lesion. The majority of these lesions are inflammatory lesions (26%). In 68% of the subjects, a certain degree of supraglottic constriction was observed. Despite the overall good voice quality, videolaryngostroboscopy showed a high presence of vocal fold lesions and supraglottic constriction during phonation.

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.

Quantitative study of voice dysfunction after thyroidectomy

Up to 80% of patients without a recurrent laryngeal nerve palsy report alteration in their voice after a thyroid procedure. The aims of this study were (1) to quantify voice changes after thyroid operation; (2) to correlate the changes to the extent of operation; and (3) to correlate voice changes to intraoperative recurrent laryngeal nerve swelling. Patients undergoing total and hemithyroidectomy were recruited prospectively from the Monash University Endocrine Surgery Unit during a 12-month period. Voice quality was scored subjectively using the Voice Disorder Index (score 0-40, from best to worst) and objectively using the Dysphonia Severity Index (score -5 to 5, from worst to best), before and after operation. These assessments were carried out by 2 speech pathologists. Recurrent laryngeal nerve diameter was measured intraoperatively at the commencement and conclusion of the lobectomy, using Vernier calipers with a resolution of 0.1mm. Statistical methods used included Student t test, χ2, Wilcoxon signed-rank test, and linear regression. A total of 62 patients were included in the study, with a mean age of 48±16years and a female preponderance (6:1). Overall, the voice quality deteriorated both subjectively (mean Voice Disorder Index 4.2±0.8-9.4±1.2, P<.01) and objectively (mean Dysphonia Severity Index 3.9±0.3-2.8±0.3, P<.01) with thyroid operation. Patients who underwent either hemi- or total thyroidectomy both reportedsignificant deterioration of voice (mean Voice Disorder Index 5.4±1.5-7.9±1.4, P=.02 and 3.4±0.7-10.4±1.8, P<.01 respectively). However, on objective assessment, only total thyroidectomy patients showed significant deterioration (Mean Dysphonia Severity Index 4.0±0.3-2.5±0.3, P<.01). At 6-12months, both Voice Disorder Index and DSI returned to preoperative levels. Intraoperatively,the recurrent laryngeal nerve diameter increased by 0.58±0.05mm (1.82±0.05mm-2.40±0.05mm; P<.01). In hemithyroidectomy patients, the degree of nerve swelling correlated with the degree of deterioration in objective voice assessment, in that the greater the increase in recurrent laryngeal nerve diameter, the worse the Dysphonia Severity Index score (coefficient -0.4, P=.03). This was not the case in the total thyroidectomy patients. Voice quality deteriorates with thyroid operation despite functionally intact recurrent laryngeal nerve. While likely multifactorial, the degree of deterioration is related to the extent of operation and may also be related to the degree of recurrent laryngeal nerve swelling. Spontaneous resolution is expected in the majority of patients.

Pitch Elevation in Male-to-female Transgender Persons—the Würzburg Approach

The present study reports objective and subjective voice results of Wendler's glottoplasty modified by Hagen. This is an outcomes research study. A total of 21 patients underwent Wendler's glottoplasty modified by Hagen. Parameters in the follow-up session were laryngoscopy, voice range profile, Voice Handicap Index, Life Satisfaction Questionnaire, and a visual analog scale for individual satisfaction with the voice. The fundamental frequency was elevated into the typical female fundamental frequency range. Furthermore, an elevation of the lower frequency limit was shown without a reduction of the frequency range. About one third of the population feels affected by the restricted dynamic range. This change of the vocal pitch is seen as part of the voice feminization by some of the patients. The Dysphonia Severity Index as a marker for voice quality was unchanged. Subjective satisfaction with the voice showed a strong correlation with the individual elevation of the pitch. Wendler's glottoplasty modified by Hagen is an effective and low-risk method of raising the vocal pitch of male-to-female transgender persons. However, elevated Scores of the Voice Handicap Index indicated that in everyday life, transgender persons continue to feel handicapped because of their voice. Another indicator for the lack of social acceptance and integration is the reduced general life satisfaction in the Life Satisfaction Questionnaire especially in the domain "friends, acquaintances, relatives." Therefore, a better multidisciplinary therapy concept for voice feminization is necessary.

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.

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.

Characteristics of a Dysphonic Population Referred for Voice Assessment and/or Voice Therapy

Objective: The aim of this study was to define patient characteristics of a dysphonic population in terms of voice disorder, gender, age, and subjective and objective vocal parameters and to explore the relevant characteristics of the most frequent groups of voice disorders. Patients and Methods: Patient records from 4,447 subjects referred for voice assessment and/or voice therapy were analyzed. Results: Significantly more cases of dysphonia were structural as compared to nonstructural. This significant difference was found in almost all age groups. Significantly more women were diagnosed with dysphonia than men. The most common symptom was light-to-moderate hoarseness. The average voice handicap index was 31 and the average dysphonia severity index was -0.6. Vocal fold nodules (VFN), functional voice disorders (FVD) and vocal fold paralysis (VFP) were the three most frequently diagnosed vocal pathologies and were analyzed in detail. Women were found to be significantly more vulnerable to FVD, VFN and cysts, whereas men were significantly more often diagnosed with carcinoma, hyperkeratosis, laryngitis, papillomatosis, presbyphonia, puberphonia and VFP. Conclusions: The results of this study allow a better estimation of the clinical needs and costs for a specific dysphonic population looking for help and highlight the gender-related risks of specific voice disorders.

Timing of Voice Therapy: A Primary Investigation of Voice Outcomes for Surgical Benign Vocal Fold Lesion Patients

This study aims to examine the role of timing of speech-language pathology intervention on outcomes for surgical patients with benign vocal fold lesions as measured by a patient self-reported scale (Voice Handicap Index [VHI]) and objective acoustic measures (jitter %, Dysphonia Severity Index, noise-to-harmonics ratio). For the purpose of this study, interventions were categorized into three groups: preoperative (preoperative counseling session followed by postoperative therapy), pre- and postoperative therapy (multiple therapy sessions preoperatively and postoperatively), and postoperative therapy alone. Retrospective review of a prospective disease-specific outcomes database. Subjects identified in the database consisted of 12 preoperative counseling participants (six male, six female), 11 pre- and postoperative therapy participants (three male, eight female), and eight postoperative therapy only participants (three male, five female). Preoperative and postoperative VHI, Dysphonia Severity Index, jitter, and noise-to-harmonics ratio scores were compared between groups using paired t tests with a multiple comparison Bonferroni correction (α = 0.016). Despite lack of statistically significant changes in acoustic measures, groups receiving preoperative intervention whether with postoperative therapy or not, had statistically significant improvements in their VHI total scores (P = 0.001 for preoperative only and P = 0.0002 for pre- and postoperative therapy). Patients receiving speech pathology services before surgery for benign vocal fold lesions with or without postoperative therapy demonstrated greater gains in their subjective view of vocal function and quality as measured by the VHI.

Effect of Two Isolated Vocal-facilitating Techniques Chant Talk and Pitch Inflections on the Phonation of Female Speech-language Pathology Students: A Pilot Study

The purpose of this study was to determine the effect of the isolated vocal-facilitating techniques Chant Talk and Pitch Inflections on the phonation of healthy female speech-language pathology (SLP) students. A multigroup pretest-posttest design was used. A homogenous group of 40 healthy female SLP students with a mean age of 18.7 years were randomly assigned into 3 groups: a Chant Talk group (practicing Chant Talk across 18 weeks), a Pitch Inflections group (practicing Pitch Inflections across 18 weeks), and a control group (practicing no facilitating techniques). To compare vocal measures before and after this time span, an identical objective voice assessment protocol (aerodynamic measurement, acoustic analysis, voice range profile, and Dysphonia Severity Index) was performed in the 3 groups. Both Chant Talk and Pitch Inflections groups resulted in a significant decrease of the acoustic measure noise-to-harmonics ratio compared with the control group. The Chant Talk group resulted in a significant increase in the acoustic measure fundamental frequency compared with the control group. The results of this pilot study suggest that the facilitating techniques Chant Talk and Pitch Inflections may improve the objective measure of breathiness (noise-to-harmonics ratio) in healthy female SLP students.

Correlation of the Dysphonia Severity Index (DSI), Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V), and Gender in Brazilians With and Without Voice Disorders

This study aims to analyze the Dysphonia Severity Index (DSI) in Brazilians with or without voice disorders and investigate DSI's correlation with gender and auditory-perceptual evaluation data obtained via the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) protocol. A total of 66 Brazilian adults from both genders participated in the study, including 24 patients with dysphonia confirmed on laryngeal examination (dysphonic group [DG]) and 42 volunteers without voice or hearing complaints and without auditory-perceptual voice disorders (nondysphonic group [NDG]). The vocal tasks included in CAPE-V and DSI were performed and recorded. Data were analyzed by means of the independent t test, the Mann-Whitney U test, and Pearson correlation at the 5% significance level. Differences were found in the mean DSI values between the DG and the NDG. Differences were also found in all DSI items between the groups, except for the highest frequency parameter. In the DG, a moderate negative correlation was detected between overall dysphonia severity (CAPE-V) and DSI value, and between breathiness and DSI value, and a weak negative correlation was detected between DSI value and roughness. In the NDG, the maximum phonation time was higher among males. In both groups, the highest frequency parameter was higher among females. The DSI discriminated among Brazilians with or without voice disorders. A correlation was found between some aspects of the DSI and the CAPE-V but not between DSI and gender.

An Analysis of the Effects of Voice Therapy on Patients With Early Vocal Fold Polyps

This study aimed to analyze the voice characteristics of patients with early vocal fold polyps and to investigate the effects of voice therapy on patients. Voice therapy was conducted on 88 patients with early vocal fold polyps in an experimental group. Laryngostroboscopy, the voice handicap index (VHI), and the dysphonia severity index (DSI) were applied to evaluate the patients' voice quality before and after treatment. Thirty-one healthy volunteers also underwent evaluation of voice quality as a control group. The intergroup and intragroup differences in the results of laryngostroboscopy, VHI, and DSI were compared statistically. In the experimental group, 22 patients withdrew from the treatment for various reasons. After voice therapy, the cure rate was 30.3% (20/66). All the VHI values in the experimental group before treatment were statistically worse than the values in the control group. The P and T values of the VHI in the experimental group were still worse after treatment than the values in the control group, although the VHI did improve after treatment in the experimental group. The maximum phonation time (MPT), jitter, I-low, and DSI were statistically different between the control group and the experimental group both before and after treatment. Furthermore, the MPT, jitter, F0-high, I-low, and DSI improved after treatment in the experimental group. Patients with early vocal fold polyps have some degree of subjective and objective dysphonia. Voice therapy can improve the voice quality in these patients.

Effectiveness of Chewing Technique on the Phonation of Female Speech-Language Pathology Students: A Pilot Study

The purpose of this study was to determine how use of the vocal facilitating technique, chewing, affected the phonation of speech-language pathology (SLP) students. A pretest-posttest randomized control group design was used. Twenty-seven healthy female SLP students were randomly assigned into either an experimental group or a control group. The experimental group practiced chewing exercises across 18weeks, whereas the control group received no vocal facilitating techniques. Both groups completed pre- and post- objective voice assessment measures (aerodynamic measurement, acoustic analysis, voice range profile, and Dysphonia Severity Index). Differences between pre- and post-data were compared between the experimental and control group using an independent sample t test. Compared to the control group, chewing resulted in a significant decrease in jitter and noise-to-harmonic ratio (NHR), a significant increase in fundamental frequency (fo), a significant expansion of the voice range profile, and a significant increase in Dysphonia Severity Index (DSI). Shimmer and maximum phonation time (MPT) were not significantly different between groups. The results of this pilot study suggest that the vocal facilitating technique, chewing, may improve objective vocal measures in healthy female SLP students.

Observation of the dysphonia severity index in evaluating curative effect of vocal cord polyp surgery

To investigate the applicability of the eysphonia severity index (DSI) in evaluating effects of surgery between before and after groups of vocal polyp patients. Analyses of measurement data pre and pro-surgery of 70 vocal polyp patients and 35 no voice disorders volunteers (control group). The voice quality was measured subjectively with the voice handicap index (VHI), the GRBAS and fiber electronic laryngoscopy. Measures of maximum phonation time (MPT), shimmer and jitter were obtained for each subject by using DiVAS 2.30 (XION, Germany). The DiVAS 2.30 had spotanenously calculate the scores of DSI. Using SPSS 17.0 to find the differences of DSI scores among the three groups by one-way ANOVA variance analysis. And finding out of the correlation with DSI scores and VHI scores, GRBAS, MPT, jitter and shimmer. DSI improved significantly after surgery in the vocal polyps group (mean difference DSI -2.92 and 1.87, respectively) and also in the control group (mean difference DSI -2.92 and 2.30, respectively). However, no significant difference between the control group and the after surgery group. By using Pearson correlation analysis, this study observed a strong correlation between the DSI scores and the VHI scores, the values of GRBAS, shimmer (P < 0.01). DSI is an effective and high accuracy multi-parameter system for evaluation of vocal cord polyp patients as an independent assessment of dysphonia. DSI also can be used in evaluation of the effects of the vocal polyps surgery.

Effectiveness of a Voice Training Program for Student Teachers on Vocal Health

The effectiveness of a preventive training program on vocal health for German student teachers was investigated on specific vocal parameters. The voice quality as described by the Dysphonia Severity Index of 204 student teachers (training group: n=123; control group: n=81) was measured at the beginning and at the end of the student teachers training period (duration 1.5years). Additionally, for investigating the voice-carrying capacity, a vocal loading test (VLT) was performed. Finally, participants had to provide a subjective judgment of a possible Voice Handicap Index. The training program improved the voice quality of the trained group compared with that of the control group, whose voice quality declined. The trained group was also able to better sustain their voice quality across the VLT than the control group. Both groups, however, reported a similar increase in subjective vocal strain. The presented training program clearly showed a positive impact on the voice quality and the vocal capacity. The results maintain the importance of such a training program to be integrated in the education and occupational routine of teachers.

Impact of Vagal Nerve Stimulation on Objective Vocal Quality, a Pilot Study

The purpose of this study was to determine the impact of vagal nerve stimulation (VNS) on the vocal quality using the dysphonia severity index (DSI). It was hypothesized that the objective vocal quality and other vocal characteristics are disordered in comparison with an age- and gender-matched control group. In addition, the acoustic vocal parameters were compared during three conditions: at rest, during normal stimulation, and raised stimulation. A significant relation between the amount of stimulation and the presence of disturbed acoustic parameters was hypothesized. Subjective (auditory-perceptual evaluation and voice handicap index) and objective (aerodynamic, vocal range, acoustic measurements and determination of the DSI) measurements were used to determine the vocal quality in 13 subjects with VNS in three different conditions (at rest and during normal and raised stimulation) and the age- and gender-matched control group. The subjects with VNS had a disordered perceptual vocal quality mainly characterized by the presence of a moderate roughness and slight breathiness, and the objective vocal quality by means of the DSI value is -2.4. During stimulation and especially during raised stimulation, the fundamental frequency is significantly increased. However, the subjects experienced no psychosocial handicapping effect of the vocal quality on the quality of life. Subjects with VNS have typical vocal characteristics. Ear, nose, and throat specialists and voice therapist must be aware of the presence of this vocal pattern at rest and during normal and raised stimulation. Especially, professional voice users and elite vocal performers must be informed before implantation.

Vocal effectiveness of speech-language pathology students: Before and after voice use during service delivery.

BackgroundAs a professional voice user, it is imperative that a speech-language pathologist's (SLP) vocal effectiveness remain consistent throughout the day. Many factors may contribute to reduced vocal effectiveness, including prolonged voice use, vocally abusive behaviours, poor vocal hygiene and environmental factors.ObjectivesTo determine the effect of service delivery on the perceptual and acoustic features of voice.MethodA quasi-experimental., pre-test–post-test research design was used. Participants included third- and final-year speech-language pathology students at the University of Pretoria (South Africa). Voice parameters were evaluated in a pre-test measurement, after which the participants provided two consecutive hours of therapy. A post-test measurement was then completed. Data analysis consisted of an instrumental analysis in which the multidimensional voice programme (MDVP) and the voice range profile (VRP) were used to measure vocal parameters and then calculate the dysphonia severity index (DSI). The GRBASI scale was used to conduct a perceptual analysis of voice quality. Data were processed using descriptive statistics to determine change in each measured parameter after service delivery.ResultsA change of clinical significance was observed in the acoustic and perceptual parameters of voice.ConclusionGuidelines for SLPs in order to maintain optimal vocal effectiveness were suggested.

Early Voice Therapy in Patients with Unilateral Vocal Fold Paralysis

Objective: The purpose of this work was to study the efficacy of early voice therapy in the management of patients with unilateral vocal fold paralysis. Patients and Methods: Three groups of patients suffering from unilateral vocal fold paralysis were subjected to a protocol of voice evaluation including auditory-perceptual voice analysis, the Dysphonia Severity Index (DSI) and the 20-item Voice Problem Self-Assessment Scale (VPSS-20). Patients were also examined using video laryngostroboscopy. The early voice therapy group was enrolled in a voice therapy program for 16 sessions as soon as the patients were diagnosed; the second group of patients did not receive voice therapy during the course of their ailment. The late voice therapy group was enrolled in a voice therapy after a period of at least 6 months following the onset of vocal fold paralysis. All studied patients were reevaluated after a period of 2 months. Results: The early voice therapy group showed better outcomes regarding VPSS-20 scores, auditory-perceptual voice analysis as well as the DSI. Conclusion: Early onset of voice therapy may enhance the reduction in glottal gap and improvement of voice quality by hindering the development of faulty hyperfunctional compensatory behaviors; early voice therapy may therefore enhance the patient's quality of life.

Correlation between the quantitative video laryngostroboscopic measurements and parameters of multidimensional voice assessment

The purpose of this study was to evaluate quantitatively the parameters of the video laryngostroboscopy (VLS) and determine correlations between the VLS parameters and acoustic vocal function parameters. Digital VLS recordings, acoustic voice assessment, calculation of dysphonia severity index (DSI) and registration of voice range profile (VRP) were performed for 206 individuals: 50 healthy and 156 patients with mass lesions of vocal folds and paralysis. 90 of lesions were unilateral, 66 – bilateral. VLS parameters were derived using objective measures made from a single image taken from the VLS recording of a sustained vowel: glottal areas, glottal widths and distances, vocal fold angles. As the result of Fisher's linear discriminant analysis, 11 VLS measurements were identified to be relevant distinguishing between normal and pathological voice groups. Correlations between the VLS parameters and results of acoustic voice analysis parameters, DSI and VRP measurements were tested using Pearson's correlation coefficient. The correlations of VLS variables and acoustic voice measurements were moderate and statistically significant. In pathological voices numerical values of VLS parameters measured reveal significant deviances from these in normal voice; therefore quantification of VLS parameters appears to be sensitive and specific distinguishing normal and pathological voices patients groups. Analysis of correlations between the quantitative measurements obtained via VLS and acoustic voice parameters provides more versatile approach into the pathophysiology of phonation and suggests the documented and measurable evidence of complex mechanisms of vocal function.