Dysphonic Group Research Articles

Cross-cultural Adaptation of the Iranian Version of the Voice Symptom Scale

Background and Objectives: This research aims to evaluate the validity and reliability of the Persian version of the voice symptom scale (VoiSS) questionnaire. We also sought to determine the best cut-off point to classify high-risk populations into controls (participants) and dysphonic patients. Methods: The study was conducted in 3 main steps. The translation process was carried out by a pair of Iranian bilingual speech-language pathologists along with an expert panel. For the validity study, the questionnaire was administered to 268 cases that were suspected of dysphonia. Finally, to assess the reliability, the questionnaire was completed twice in 2 weeks by 40 dysphonia patients. To normalize data generation 107 individuals without dysphonia completed the P-VoiSS, after that the cutoff value of the P-VoiSS was calculated. Results: Cronbach’s α was estimated at 0.914, and for impairment, emotional, and physical domains, it was 0.877, 0.926, and 0.725, respectively. We also estimated intra-cluster correlation (ICC) of 0.984 indicating high reproducibility of the Persian VoiSS questionnaire. The estimated intra-cluster correlation (ICC) for subscale was 0.962 for impairment, 0.989 for emotional, and 0.952 for physical domains. The Mean±SD score of the questionnaire for the healthy group was 10.1±5.9, while it was statistically higher in dysphonia patients (44.1±20.6). The statistical difference was observed in the subscales of the questionnaire between healthy and dysphonia groups (P<0.05). The exploratory factor analysis determined that the Persian VoiSS has three subtest/latent factors like the original form. We also estimate the best cut-point at 20.5. Conclusion: The Persian adaptation of VoiSS is a dependable and effective tool that can be utilized for screening high-risk populations.

Validation of the Acoustic Voice Quality Index Version 03.01 in Turkish

ObjectivesThe aim of this study was to validate the Acoustic Voice Quality Index (AVQI) version 3.01 in the Turkish-speaking population. Materials and methodsConcatenated voice samples of the sustained vowel [a:] and continuous speech were collected from 127 dysphonic and 128 normophonic participants. The auditory-perceptual evaluation was performed by five experienced raters using the Grade parameter of the GRBAS scale. Rater reliability, concurrent validity, diagnostic accuracy, and differences between normophonic and dysphonic groups were analyzed for the AVQI version 3.01. ResultsThe number of syllables for the standardized reading text with the concatenation of the voiced parts lasting around 3 seconds (mean=3.84s) was 36. The ICC values of intra-rater reliability of G scores of five raters were excellent (mean ICC=0.934), and of inter-rater reliability they varied between moderate and excellent (mean ICC=0.786). AVQIv3 demonstrated a high diagnostic accuracy with AUC = 0.906 in identifying disrupted versus normal voice quality. With sensitivity of 80% and specificity of 94%, AVQIv3 = 2.345 was the cut-off point that differentiated most accurately between normophonic and dysphonic voices in Turkish. ConclusionAVQIv3 is an ecologically valid tool for objective differentiation between dysphonic and normal voices in the Turkish language.

Validation of the Spanish Version of the Voice-Related Quality of Life Questionnaire: Psychometric Properties and Clinical Applications

Introduction: The present study aimed to validate the Voice-Related Quality of Life (V-RQOL), vocal self-assessment questionnaire for Spanish. Methods: The validation and psychometric properties were developed according to the criteria of the Scientific Advisory Committee of Medical Outcomes Trust (SAC). The Spanish translation for linguistic and cultural adaptation of the V-RQOL was used. The study involved 193 participants, including 90 vocally healthy individuals and 103 patients with voice disorders, to establish validity. To evaluate reliability, the protocol was applied to 40 participants with dysphonia, who answered it twice before the treatment. Then to determine response changes, the responses of 13 dysphonic participants to the V-RQOL for Spanish were analyzed after intervention and then compared to the initial ones. Clinicians contrasted subjects’ V-RQOL results with a perceptual analysis of voice quality using the GRBAS scale. In order to determine sensitivity and specificity cut-off values, tools results were subjected to the receiver operating characteristic curve analysis. The sensitivity was obtained from the experimental group (dysphonic group) and the specificity from the control group (non-dysphonic group). Results: This version of the V-RQOL questionnaire may be used as part of the standard assessment process of people with voice complaints and as an outcome of treatment efficacy in clinical trials. Conclusion: A validation of the V-RQOL for Spanish in Chilean population was achieved.

Evaluation of Pediatric Posterior Glottic Diastasis Using Dynamic Voice Computed Tomography.

Posterior glottic diastasis (PGD) is an underappreciated etiology of dysphonia in patients with prior airway reconstruction or prolonged intubation. In endoscopic posterior cricoid reduction (ePCR), cricoid is removed to minimize the posterior glottic gap. Dynamic voice computed tomography (DVCT) permits visualization of the posterior glottis, estimating the amount of cricoid to be removed. Posterior glottic gaps in patients undergoing ePCR were compared to non-dysphonic patients to describe pediatric PGD and establish surgical parameters for ePCR. DVCTs performed in non-dysphonic patients and dysphonic patients undergoing ePCR from 2014 to 2023 were reviewed. EPCR operative reports were queried. Pre- and postoperative Pediatric Voice Handicap Index (pVHI) and Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) scores and aerodynamic measures were reviewed. Seventeen pediatric patients who underwent ePCR and 19 non-dysphonic patients were included. Posterior glottic gaps were significantly larger in the dysphonic group (median 2.4 mm [IQR: 2.0, 2.8] vs. 1.3 mm [IQR: 1.1, 1.7], p < 0.001). Mean width of the cricoid removed was 1.6 mm (SD 0.4 mm). Mean (SD) pre- and postoperative pVHI scores were 55.5 (19.9) and 34.6 (16.0; p < 0.001). Mean (SD) pre- and postoperative CAPE-V scores were 52.7 (15.4) and 36.5 (20.4; p < 0.001), respectively. Children in this cohort tolerated an average 1.3 mm posterior glottic gap without dysphonia. Dysphonic patients with PGD had a median 2.4 mm gap and underwent cricoid reduction by 1.6 mm. All ePCR patients demonstrated improvement in dysphonia. Results seek to optimize the management of pediatric PGD and present a safe and effective amount of cricoid to remove during ePCR. 4 Laryngoscope, 2024.

Comparing five-factor personality traits and psychological distress between dysphonic patients and individuals with vocally healthy voices.

It was reported that voice can carry information about personality and psychological distress. In the current study, the relationship between five-factor personality traits and psychological distress with voice was enlightened from diverse aspects. A total of 119 participants (55 with and 64 without dysphonia) sustained vowels /a/ and /i/, read six standard sentences, and answered a question. Three raters auditory-perceptually evaluated the vocal samples using the Persian version of CAPE-V. The participants were distributed into four groups (vocally healthy, mild, moderate, and severe dysphonia). They completed two questionnaires: NEO Five-Factor Inventory (NEO-FFI) and Depression, Anxiety, and Stress Scale-21. Results showed that the conscientiousness (U=1146.500, z=-3.27, p=.001) in the dysphonia group was significantly less than the vocally healthy group. Depression (U=1381.000, z=-2.03, p=.042) and anxiety (U=1181.000, z=-3.10, p=.002) in the dysphonia group were significantly higher than in the vocally healthy group. In comparing different abnormal overall voice qualities, the mild dysphonia group revealed significantly lower conscientiousness (p=.001) and significantly higher anxiety (p=.002) relative to the vocally healthy group. Findings indicated that the conscientiousness trait could play an influential role in persons with dysphonia and its psychological status. The voice care team should consider conscientiousness and psychological distress during the assessment and treatment of dysphonic patients.

Functional and structural abnormalities of the speech disorders: a multimodal activation likelihood estimation meta-analysis.

Speech disorders are associated with different degrees of functional and structural abnormalities. However, the abnormalities associated with specific disorders, and the common abnormalities shown by all disorders, remain unclear. Herein, a meta-analysis was conducted to integrate the results of 70 studies that compared 1843 speech disorder patients (dysarthria, dysphonia, stuttering, and aphasia) to 1950 healthy controls in terms of brain activity, functional connectivity, gray matter, and white matter fractional anisotropy. The analysis revealed that compared to controls, the dysarthria group showed higher activity in the left superior temporal gyrus and lower activity in the left postcentral gyrus. The dysphonia group had higher activity in the right precentral and postcentral gyrus. The stuttering group had higher activity in the right inferior frontal gyrus and lower activity in the left inferior frontal gyrus. The aphasia group showed lower activity in the bilateral anterior cingulate gyrus and left superior frontal gyrus. Across the four disorders, there were concurrent lower activity, gray matter, and fractional anisotropy in motor and auditory cortices, and stronger connectivity between the default mode network and frontoparietal network. These findings enhance our understanding of the neural basis of speech disorders, potentially aiding clinical diagnosis and intervention.

Adaptation and Validation of the Mandarin Chinese Version of the Pediatric Voice Handicap Index-10 (pVHI-10).

The purpose of this study was to adapt and validate the Mandarin Chinese version of the pediatric Voice Handicap Index-10 (pVHI-10). A cross-sectional study was conducted from January 2018 to December 2019. A total of 422 parents completed the questionnaire, including 283 parents of children with voice disorders (dysphonic group) and 139 parents of children without voice disorders (control group). Internal consistency, test-retest reliability, clinical effectiveness, and cut-off value were evaluated. In the dysphonic group, the internal consistency of the Mandarin Chinese version of pVHI-10 was excellent (Cronbach's α=0.95). The test-retest reliability was excellent for the total score of the Mandarin Chinese version of pVHI-10 (interclass correlation coefficient=0.916). The total scores as well as scores on individual items were significantly higher in the dyphonic group compared to those in the control group (P <0.001). In addition, the optimum cut-off value for the Mandarin Chinese version of pVHI-10 was 6.5 (87% sensitivity and 86.3% specificity, respectively). The Mandarin Chinese version of the pVHI-10 is a valid tool that evaluates the quality of life of children with voice disorders from the parents' perspective.

Determining Cutoff Point in Bahasa Malaysia Version of Voice Handicap Index-10 (mVHI-10)

Determining the cutoff point on Bahasa Malaysia version of Voice Handicap Index (mVHI-10) questionnaire scores for distinguishing between dysphonic and normal voice samples. A cross-sectional study was conducted in the tertiary hospital, Otorhinolaryngology-Head and Neck clinic. The study involved 205 subjects (105 in the dysphonia group; 100 in the normal group) with a complete database of flexible laryngoscopy/stroboscopy, voice recording, acoustic analysis, and mVHI-10 score. A sample with a discrepancy between subjective evaluation and acoustic analysis results was excluded from the study. Each classified dataset matched with the respective mVHI-10 questionnaire score. Finally, all the collected data were subjected to data analysis. The best cutoff point for mVHI-10 was 7.5 by the receiver operating characteristiccurve, with an area under the curve value of 0.997. Its sensitivity, specificity, positive predictive value, and negative predictive value were 92.4%, 100.0%, 100.0%, and 93.0%, respectively. The best cutoff point for mVHI-10 is 7.5, as determined by stringent data evaluation and rigorous statistical analysis. With excellent diagnostic accuracy properties, it enhances the usage of the mVHI-10 questionnaire as an excellent screening tool. Nevertheless, we advocate multidimensional voice assessment for diagnostic purposes.

Adaptation and Validation of Voice Activity and Participation Profile in Tamil

Introduction: The study aims to adapt, translate, and validate Voice Activity and Participation Profile in Tamil (VAPP-Tamil) and determine activity limitations and participation restrictions in individuals with dysphonia. Materials and Methods: The original English version of VAPP was adapted culturally and translated into a Tamil questionnaire. Further, reverse translation, content validity, and pilot study were performed. The final version of the VAPP-Tamil questionnaire was administered to 127 healthy controls and 80 subjects with dysphonia. The tool was subjected to validity and reliability measures and was compared with Tamil Voice-Related Quality of Life (TVRQoL) questionnaire. Results: The final version of VAPP-Tamil questionnaire had good internal consistency and acceptable construct validity. Significant differences in mean scores were obtained for the control and dysphonia groups. VAPP-Tamil obtained a strong positive correlation when compared with TVRQoL. The cutoff score for interpretation of the severity of the voice problem was also determined for the questionnaire. Conclusion: VAPP-Tamil is a valid and reliable questionnaire to assess and subjectively quantify the impact of voice problems on quality of life (QoL) of individuals with dysphonia. It provides significant information on the impact of voice on an individual’s activity and participation. Thus, the questionnaire can be used by SLPs for individuals with dysphonia who are native Tamil speakers in assessing their QoL, planning intervention, evaluating outcomes of intervention, and counseling purposes.

A comparative study of the vocal parameters between hypofunctional and hyperfunctional dysphonia using perceptual and cepstral spectral index of dysphonia measures

Background: The main goal of the present study was to obtain the cepstral spectral index of dysphonia (CSID) scores for normophonic, hypo-functional dysphonic and hyper-functional dysphonic Indian population along with correlation of CSID and GRBAS scores for normophonic, hypo-functional dysphonic and hyper-functional dysphonic population using sustained production of vowel and oral passage of Bengali language. Methods: A total of 60 participants between 20-50 years were selected for the study. The participants were divided into three groups viz., 30 normal subjects, 15 subjects with hypofunctional dysphonia and 15 subjects with hyperfunctional dysphonia. The subjects were screened for speech and hearing defects. Recordings of sustained vowels and passage were done and then fed to measure CSID through PRAAT and software developed by C-DAC. Statistical analyses were done for the analyzed data using SPSS. Results: Significant differences (p&lt;0.05) were found in CSID scores across hypofunctional dysphonia group and hyperfunctional dysphonia group when compared to normophonia group. There were no significant differences (p&gt;0.05) between hypofunctional and hyperfunctional dysphonia group in CSID score. A significantly strong correlation of CSID scores with the ‘G’ rating of GRBAS scores (p&lt;0.01) were found for both hypofunctional dysphonia and hyperfunctional dysphonia groups. ROC analysis showed high sensitivity and specificity of CSID scores in two dysphonia groups with respect to normophonia group. Conclusions: The current study revealed significant differences obtained in CSID scores across normophonia, hypofunctional dysphonia and hyperfunctional dysphonia groups suggesting it as assessment tool to determine the presence of dysphonia.

Relationship Between Aerodynamic Measurement of Maximum Phonation Time With Acoustic Analysis and the Effects of Sex and Dysphonia Type.

This study set out to uncover the correlation between maximum phonation time (MPT) with acoustic and cepstral analysis in the dysphonic and control groups, considering the effects of sex and dysphonia type. For this cross-sectional study, a sample of 179 attendees (141 dysphonic and 38 control) were randomly selected and requested to sustain the vowel /a/ as long as they could with their habitual pitch and loudness. Reading standard sentences and conversational connected speech tasks were obtained too. Using Praat, the MPT, jitter, shimmer, noise-to-harmonic ratio, cepstral peak prominence (CPP), and smoothed cepstral peak prominence (CPPS) were calculated in the target vocal tasks. There was a very low to low significant correlation (r=0.00-0.50) between MPT amounts and acoustic analysis in the dysphonic group (P < 0.05), except for between MPT with shimmer (P > 0.05). In contrast, findings showed no significant correlation between MPT and acoustic analysis in the control group, not even separated by sex (P > 0.05). There was a very low to low correlation between MPT amounts and acoustic analysis in the male dysphonic group (P < 0.05), except for the MPT with shimmer (P > 0.05). There was no significant correlation between MPT and acoustic analysis in the female dysphonic group (P > 0.05), except for MPT with CPP (sustained vowel) (P < 0.05). Finally, very low to high correlations between MPT and some of the acoustic analysis in all the different dysphonia types were observed (P < 0.05). MPT contains some information about the acoustic features of the dysphonic voice, specifically the CPP and smoothed cepstral peak prominence. The data suggested that the observed relationship between MPT and the acoustic analysis has the capacity to be considered for the development of new multiparametric tests of voice assessment in dysphonia, regarding the sex and dysphonia type.

Investigation of the Cepstral Spectral Acoustic Analysis for Classifying the Severity of Dysphonia

The advantages of cepstral measurements in the evaluation of dysphonia have been noted in previous studies. However, there is an unclarity regarding the results of cepstral analyzes effect in determining the severity of dysphonia. The aims of this study were to determine the cut-off values of cepstral peak prominence, cepstral peak prominence standard deviation, low frequency/ high frequency ratio, low frequency/high frequency ratio standard deviation, and cepstral spectral index of dysphonia for predicting the voice severity within a Turkish speaking population, as well as to confirm the discriminative power of these cut-off values. One hundred ninety-five individuals with voice disorders and an equal number of age and gender-matched individuals without voice disorders were included. Included subjects had visited the Hacettepe University Hospitals Speech and Language Therapy Department for voice evaluation between January 2017 and September 2021. The voice recordings from all participants included the six CAPE-V/Turkish sentences and sustained vowel /a/. Three raters provided auditory perceptual ratings of the voice samples using the GRBAS scale (grade) and overall severity for the CAPE-V/Turkish. Participants were categorized into normal and mild, moderate, and severely dysphonic groups based on the auditory perceptual evaluation. Analysis of Dysphonia in Speech and Voice (ADSV) software was used for cepstral spectral acoustic analysis. In the sustained vowel context, the area under the curve (ROC) for the CSID value was >0.8, except for mild vs. moderate dysphonia groups. In connected speech contexts, the ROC of the CPP value was also >0.8, except for normal vs. mild dysphonia groups. The cut-off values of CPP and CSID demonstrated high sensitivity and specificity for predicting voice severities. The cut-off values for the parameters that predicted voice severities showed a significant degree of discriminative power for categorizing voice severities among Turkish-speaking people.

음성장애 성인 여성과 정상음성 성인 여성 간 진성구와 가성구의 음성범위프로파일 비교*

This study compared voice range profiles (VRPs) of modal and falsetto register in 53 dysphonic and 53 non-dysphonic adult women with gliding vowel /a/’. The results shows that maximum fundamental frequency (F0_MAX), maximum intensity (I_MAX), F0 range (F0_RANGE), and intensity range (I_RANGE) are lower in the dysphonic group than in the non-dysphonic group. F0_MAX and F0_RANGE are significantly higher in falsetto register than modal register in both groups. I_MAX and I_RANGE are significantly higher in falsetto register in the non-dysphonic group, but those are not different between two registers in the dysphonic group. There was no statistically significant difference in minimum F0 (F0_MIN) and minimum intensity (I_MIN) between the two groups. Modal-falsetto register transition occurred at 378.86 Hz (F4#) in the dysphonic group and 557.79 Hz (C5#) in the non-dysphonic group, which was significantly lower in the dysphonic group. It can be seen that both modal and falsetto registers in dysphonic adult women are reduced compared to non-dysphoinc adult women, indicating that the vocal folds of dysphonic adult women are not easy to vibrate in high pitches. The results of this study would be the basic data for understanding the acoustic features of voice disorders.

Relationship of cepstral analysis with voice self-assessments in dysphonic and normal speakers.

This study aimed to investigate the relationship of cepstral analysis (Cepstral Peak Prominence [CPP] and Cepstral Peak Prominence-Smoothed [CPPS]) with voice self-assessments (The Persian version of vocal tract discomfort [VTDp] scale and non-standard hoarseness self-assessment [NHS] questionnaire). 223 participants (159 with and 64 without dysphonia) were asked to utter the vocal tasks namely vowels /a/ and /e/, six standard sentences, and a non-standard connected speech sample. CPP and CPPS were calculated in these three vocal tasks using the "Praat" software. The participants also asked to complete the VTDp scale and the NHS questionnaire. The means of frequency and severity the VTDp and the means of NHS were statistically different between the dysphonic and normal voice groups (P < 0.05), except for tickling (P > 0.05). There was a very low significant correlation between cepstral analysis with aching and in the dysphonic group (P < 0.05). However, a very low to low significant correlation between cepstral analysis with burning, tight, aching, tickling, sore, and both frequency and severity subscales scores of the VTDp in the normal voice group (P < 0.05). Moreover, the means of the cepstral analysis did not differ significantly between all scores of the NHS in the dysphonic the normal voice groups (P > 0.05), except for 1 with 3, 4, and 5 in the dysphonic group (P < 0.05). The cepstral analysis can provide some information about the status of vocal tract and person's perception of his/her own voice quality.

A Comprehensive Application for Grading Severity of Voice Based on Acoustic Voice Quality Index v.02.03

Acoustic Voice Quality Index is a six-variable acoustic model for the multiparametric measurement developed by Maryn et al. Studies have provided evidence regarding the practical usefullness, internal consistency, external validity, diagnostic accuracy, and responsiveness to change of AVQI. Recently, researchers have been exploring the utility of AVQI in classifying the voice severity. The aim of the present study was to determine the diagnostic accuracy of the AVQI v.02.03 in discriminating across the perceptual levels of dysphonia severity in 18-40 years age range in Kannada speaking population; and to develop an application to depict the AVQI based severity of dysphonia. For the study, 163 individuals in normophonic and 134 individuals in dysphonic group were considered in the age range of 18-40 years. All participants were native speakers of Kannada language. The sustained vowel /a/ and reading of standard Kannada passage were considered as stimuli for extracting AVQI analysed using AVQI script version 02.03. The AVQI cut-off values obtained were 2.50 (AROC=0.894; Sensitivity= 84.7%; Specificity= 83.1%), 4.17 (AROC=0.953; Sensitivity= 84.4%; Specificity= 88.5%) and 6.23 (AROC=1.000; Sensitivity= 100%; Specificity= 100%) for normal vs. mild, mild vs. moderate and moderate vs. severe respectively. A user friendly application was developed which provides a simplified output for AVQI cut-off values which can be comprehendible by patients with voice disorder/ non-professionals and health professionals.

Test-retest reliability and discriminatory power of multidimensional voice analysis program.

The objectives of this study were to evaluate and compare the test-retest reliability of acoustic parameters (jitter [%], shimmer [%], noise-to-harmonic ratio [NHR], and voice turbulence index [VTI]) by using multidimensional voice program, and to detect the discriminatory power of the acoustic measures with respect to dysphonic voices and normal voices. Fifty-four (25 male and 29 female) participants with voice disorders and fifty-one (27 male and 24 female) participants with normal voices were enrolled in this study. They were assessed by anamnesis, visual examination, auditory perceptual assessment (GRBAS), and acoustic measurements. The intraclass correlation coefficient was used to determine the test-retest reliability. The effect size (d value) and p value obtained from the t-test were used to determine the discriminatory power. In the normal group, good reliability was observed for jitter, shimmer, and NHR, and moderate reliability was observed for VTI. With regard to the dysphonic group, jitter, shimmer, and VTI were moderately reliable, and the NHR had good reliability. Meanwhile, the discriminatory powers of jitter and shimmer were evaluated as 'medium', and those of NHR and VTI as 'small'. The reliability and discriminatory powers of our acoustic measures were high compared with most other studies. Their level of reliability and discriminatory power can be maximised by using stringent rules. However, attaining an excellent level of reliability and discriminatory seems infeasible power owing to the variable characteristic of voice. Therefore, acoustic measures should be adopted as a complementary tool.

Validity and Reliability of the Dutch Children's Voice Handicap Index-10

Voice-related quality of life (Qol) questionnaires provide the clinician with information regarding the impact of voice disorders on the patient's well-being. The available voice-related QoL tools for Dutch-speaking children are parent-proxy in nature. However, the use of proxy measurements has been debated in the literature. The Children's Voice Handicap Index-10 (CVHI-10) is a self-reported QoL tool for dysphonic children. Therefore, the aim of this study is to develop and validate a Dutch version of the CVHI-10. Observational, prospective, cross-sectional study. The original version of the CVHI-10 was translated and adapted to Dutch according to the recommendations of the Quality of Life Special Interest Group - Translation and Cultural Adaptation group. Subsequently, the questionnaire was individually completed by 77 children (dysphonic group: n=30, control group: n=47) between eight and 14 years. In order to investigate test-retest reliability, 50% of the participants were asked to complete the questionnaire twice with an interval of 2 weeks. Internal consistency, test-retest reliability and construct validity were calculated. A receiver operating characteristic (ROC) analysis was conducted to check the sensitivity and specificity levels of the instrument. Internal consistency measured with Cronbach's alpha coefficient was 0.745. Test-retest reliability measured with intraclass correlation coefficients was 0.718. Mean total CVHI-10 score was 6.17 ± 2.7 in the dysphonic group and 2.68 ± 2.6 in the control group. The difference in total score between the groups was statistically significant (P < 0.001), suggesting that the tool has good construct validity. ROC analysis demonstrated moderate diagnostic accuracy (area under the curve=0.869) and suggested a cut-off score of 3.5. The Dutch CVHI-10 is the first self-reported voice-related QoL tool for dysphonic Dutch-speaking children. It is a valid, reliable and sensitive tool to assess the impact of a voice disorder on the child's well-being.

The Validity of Cepstral Analysis to Distinguish Between Different Levels of Perceptual Dysphonia in the Persian Vocal Tasks

The validity of cepstral analysis (Cepstral Peak Prominence [CPP] and Cepstral Peak Prominence-Smoothed [CPPS]) as an indicator of perceptual dysphonia was investigated in the Persian language STUDY DESIGN: Cross-sectional study. A total of 223 participants (159 with and 64 without dysphonia) uttered vowels /a/ and /i/, six standard sentences, and non-standard connected speech. All vocal samples were perceptually evaluated by three raters on a visual analog scale and put into four groups (normal voice, mild, moderate, and severe perpetual dysphonia). CPP and CPPS of sustained vowel /a/, reading the second standard sentence, and a sentence extracted from non-standard connected speech were established using "Praat" software. Statistical analysis involved a one-way factorial analysis of variance (ANOVA), Kruskal-Wallis H, Kendall's Tau-b correlation, t test, and receiver operating characteristics (ROC) curve. The results showed that CPP of sustained vowels and reading the standard sentence and CPPS of sustained vowel differed significantly (P < 0.05), except between the normal voice and mild perpetual dysphonia groups (P > 0.05). The CPP of non-standard connected speech, CPPS of reading the standard sentence, and non-standard connected speech differed significantly between all groups (P < 0.05). The mean of cepstral analysis of all tasks, "averaged CPP," and "averaged CPPS" were significantly different between two groups of the normal voice and perceptual dysphonia (P < 0.05). Correlation between the cepstral analysis and the perceptual ratings demonstrated that the correlation coefficients for CPP and CPPS were between 0.4 and 0.6 (P < 0.05). ROC curve analysis revealed that the area under the ROC curve for "averaged CPP" and "averaged CPPS" was greater than 0.8 (P < 0.05). The values of 22.11 and 12.29 were determined as cut-off scores of "averaged CPP" and "averaged CPPS," respectively. Cepstral analysis was known as useful clinical tool for diagnosis of perpetual dysphonia and determining its severity level in the Persian language.

Validation and Cultural Adaptation of the Arabic Version of the Aging Voice Index

The aging voice index (AVI) is a 23-item self-administered, patient-reported outcome measure. It was developed in the English language to assess the impact of voice disorders on the elderly population. This study aimed to develop an Arabic version of the AVI (A-AVI), test its reliability and validity, and assess its psychometric aspects in Arabic-speaking elderly persons with voice disorders. This was an observational, cross-sectional study involving elderly patients aged ≥60 years. Eighty-two patients with voice disorders were included in the dysphonia group and 77 patients without voice disorders were included in the vocally healthy group. The translated A-AVI and Arabic voice handicap index 10 (A-VHI10) were distributed to the study groups. The A-AVI was tested for its reliability (test-retest reliability and internal consistency) and validity (content, construct, and concurrent with A-VHI10). The A-AVI showed excellent test-retest reliability and internal consistency (intraclass correlation coefficient = 0.987 and Cronbach's alpha = 0.954, respectively). There was a significant difference in A-AVI scores between the elderly in the dysphonia and vocally healthy groups (P < 0.001). In addition, a significant correlation was demonstrated between A-AVI and A-VHI10 (r = 0.89). Unilateral vocal fold immobility and inflammatory laryngeal disorders were most frequently reported by the dysphonia group (28%). A-AVI has excellent validity and reliability in Arab-speaking elderly patients with voice disorders. It can be considered in the assessment of the effect of voice disorders on the quality of life of the elderly.

Adaptation and Validation of the Lithuanian Version of the Pediatric Voice Handicap Index

The aim of this study was to develop the Lithuanian version of the Pediatric Voice Handicap Index (pVHI) and to assess its psychometric characteristics. The Lithuanian version of the pVHI was prepared according to the standard requirements for the questionnaire translation and adaptation procedure. It also included forward and backward translations of the original questionnaire, as well as a committee review and psychometric testing of the final version of the pVHI. A total of 126 children between 4 and 13 years of age were included in the study. Two study groups were formed: a group consisting of children with dysphonia (n = 70) and a control group of children without any alterations in their voice (n = 56). The questionnaire was always completed by their parents. The results were statistically analysed to assess the reliability, validity, sensitivity and specificity of the Lithuanian version of the pVHI. High internal consistency of the Lithuanian version of the pVHI was determined (Cronbach's α = 0.938). The test-retest analysis also showed a high correlation between the two tests (r = 0.949) for both the dysphonic and control groups. The mean overall pVHI score was significantly higher (P < 0.001) in the dysphonic group than in the control group: 26.16 ± 11.84 and 2.43 ± 2.61, respectively. Similar results were obtained for all domains of pVHI. The most sensitive and specific limiting value for discrimination between the clinical and control groups was the sum of 8 points. The Lithuanian version of the pVHI is a reliable and valid instrument for the evaluation of the Voice Handicap Index in the pediatric population and can be easily applied in daily clinical practice.