Dysphonic Population Research Articles

Adult Normative Data for the OMNI-Vocal Effort Scale (VES).

To establish normative values for the OMNI-Vocal Effort Scale (VES) in healthy adults without voice complaints. Secondary objective is to determine if there are differences in perceived vocal effort across age groups and between sexes. Prospective data collection across groups. A nine-item survey was administered by speech-language pathologists with specialization in voice to consenting adults 18 years or older. Participants underwent an auditory perceptual evaluation of voice and answered questions regarding age, history of voice problems, history of voice surgery, smoking history and hearing loss. Participants were instructed to rate their perceived vocal effort in conversational speech using the OMNI-VES. Multivariant analysis was conducted. Two hundred and fifty-one participants were recruited. The majority of adults without voice complaints reported that producing conversational voice was within the "extremely easy" to "easy" range, 0-3 (92.4%). This study provides preliminary data for perceived vocal effort. The OMNI-VES may be a useful tool in understanding changes in perceived vocal effort as a result of treatment for voice disorders. Further normative data are needed between sexes, across the gender spectrum, and older adult populations. Future directions include examining the magnitude of difference between numeric values on the scale and use of the scale with other dysphonic populations. 3 Laryngoscope, 134:3726-3731, 2024.

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<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>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<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.

The German Restructured Vocal Fatigue Index and Characteristics of Dysphonic and Vocally Healthy Populations

The Vocal Fatigue Index (VFI), a 19-item psychometric self-report questionnaire, enables individuals with vocal fatigue (VF) to be identified and their complaints to be characterized. The purpose of this study was to improve the German-language version (VFI-G) and to evaluate further vocal fatigue-related characteristics of dysphonic and control populations. The VFI-G was restructured by replacing the three factors that structured the original: (1) tiredness of voice and voice avoidance; (2) physical discomfort; and (3) improvement of symptoms with rest, with two clusters developed on the basis of the results of a factor analysis by Nanjundeswaran etal. (2019). The two new clusters are: (1) tiredness and avoidance plus physical discomfort; and (2) symptom improvement through rest. One hundred one (101) individuals with voice disorders and 100 vocally healthy controls from a previous study that cross-validated the VFI-G participated in this study. In order to assess the validity of our newly adjusted VFI-G, independent samples t test, receiver operating characteristic curve, likelihood ratios and the Youden Index were calculated. The association of the two VF clusters with subject characteristics such as age, sex, type of voice disorder, and level of vocal usage was also analyzed using either a Pearson correlation or a one-way ANOVA for each of the two populations. Significantly higher scores were obtained in voice-disordered subjects in both clusters (all P values < 0.001) than in healthy-voice subjects. The threshold for cluster 1 of the VFI-G was determined as ≥17.5 (74.3% sensitivity and 88.0% specificity). The results of cluster 2 are identical to that of factor 3 of the previous cross-validation study of the VFI-G. Most subject characteristics show no significant association with cluster 1 of the VFI-G, but cluster 2 seems to be moderately associated with age, type of voice disorder and level of vocal usage in the dysphonic population. The restructured VFI-G showed improved validity and can be recommended for use in the assessment of VF. Cluster 2 is also moderately associated with several vocal fatigue-related subject characteristics of the dysphonic population.

A Comparative Study on Acoustic Voice Quality Index Between the Subjects with Spasmodic Dysphonia and Normophonia.

Spasmodic dysphonia is one of the neurologic voice disorders that is rare, chronic and long term caused by excessive or inappropriate contraction of the laryngeal muscles. The condition is more common in females than males. Assessment of such disorders requires acoustic, perceptual, instrumental and self-reported rating scales for effective diagnosis and intervention. The Acoustic Voice Quality Index is a recent, multivariate acoustic measure of dysphonia measuring the overall quality of voice including both vowels and connected speech in Praat software using AVQI script. The study aimed at comparing, observing and analysing the thresholds of AVQI obtained in the two groups. The study also targeted to show an effective co relation between GRBAS scale and thresholds of AVQI using sustained vowel /α/ and Bengali oral passage. A total of 14 participants were chosen with age range 20-50years, 7 participants were normophonic and 7 participants were having spasmodic dysphonia. Comparison was done between the 2 groups showing a significant difference (p < 0.05) between the groups. A strong co relation was obtained (α = 0.98) between two scales. Thus AVQI does the job of appropriate diagnostic tool for obtaining the scores of dysphonic population and need to be explored in other voice problems.

Cross-Cultural Adaptation and Validation of the Hong Kong-Chinese Version of Children's Voice Handicap Index

This study aimed to cross-culturally adapt and validate a Hong Kong Chinese version of the Children's Voice Handicap Index (CVHI-10(HK)) and to examine its psychometric properties as a measure of quality of life in dysphonic children. The English version of Children's Voice Handicap Index-10 was translated and adapted to Hong Kong Chinese. Content validity was obtained from ratings of an expert panel and other psychometric properties were measured from CVHI-10(HK) questionnaires completed by 63 children (Dysphonic group: n = 28, vocally-healthy Control group: n = 35) aged between eight to 14 years. CVHI-10(HK) showed good psychometric properties. Internal consistency measured with Cronbach's alpha coefficient was 0.787. It also showed excellent content validity (scale-level content validity indices ≥ 0.90) and good construct validity (between group difference in total CVHI-10(HK) score: t (33.62) = 4.393, P < 0.001, Cohen's d = 1.157). Analysis on criterion validity revealed a significant and moderate correlation between the total CVHI-10(HK) score and auditory-perceptual ratings on overall severity (Pearson's r = 0.505, P < 0.001). Receiver operating characteristic analysis showed an excellent intrinsic accuracy in discriminating the two groups of children (area under the curve = 0.808) and suggested a cutoff score of three would give the optimal sensitivity and specificity combination of the questionnaire. CVHI-10(HK) is a valid and sensitive tool that measures quality of life in dysphonic children. It is the first self-administered questionnaire that is available to the paediatric dysphonic population in Hong Kong. It may also be used as a screening tool to identify dysphonic children and those who are at risk of voice problems in the local context.

A perceptual study of the voicing feature of stop consonants after type II and III laser cordectomies

ABSTRACTThis article deals with the intelligibility of stop consonants in onset position (initial and intervocalic) as pronounced by 10 French speakers treated by a type II or III cordectomy. These surgeries cause a less efficient glottal closure and a vibratory asymmetry. The voicing contrast in consonants may be altered. The patients’ vocal samples were made up of non-words of the CVCVCVC type, where C = /p, t, k, b, d, g/ and V = /a, i, u/(n = 360), and were given to 22 French listeners for evaluation. Two identification tests were created and the listeners were asked to choose the consonants they thought they recognized (n = 7920). The results were presented in the form of a confusion matrix highlighting possible confusions of voicing and/or places of articulation. We showed high identification rates of consonants, which revealed an intact voicing contrast in this dysphonic population.

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.

Comparação dos escores dos protocolos QVV, IDV e PPAV em professores

OBJETIVO: Verificar como o impacto da disfonia em professores é caracterizado pelos protocolos QVV (Qualidade de Vida em Voz), IDV (Índice de Desvantagem Vocal) e PPAV (Perfil de Participação e Atividades Vocais), e analisar a correspondência das informações obtidas por esses instrumentos. MÉTODOS: Quarenta e seis professores com queixa vocal que procuraram atendimento fonoaudiológico e foram diagnosticados com disfonia de base comportamental responderam aos questionários QVV, IDV e PPAV, em ordem aleatória. RESULTADOS: Professores disfônicos apresentaram pior qualidade de vida no QVV em relação à população de disfônicos. O IDV não apresentou devantagem vocal expressiva. No PPAV, os professores disfônicos apresentaram menor escore em efeitos na comunicação social. Os domínios orgânico (IDV) e físico (QVV) foram considerados iguais. O PPAV apresenta aspectos não contemplados nos demais protocolos; a auto-percepção do grau da disfonia apresentou correlação com todos os domínios dos três protocolos. No QVV, as questões com maior impacto pertencem ao físico e no IDV, ao orgânico. Já no PPAV, as duas questões de maior ocorrência relacionam-se ao efeito da voz na emoção. Assim, para esta população, sugere-se a aplicação do PPAV, por contemplar aspectos não contemplados nos demais, e do QVV, pelo reduzido número de questões e por apresentar maior impacto (escores total, emocional) em relação ao IDV. CONCLUSÃO: QVV, IDV e PPAV não apresentam as mesmas informações em professores disfônicos. Os domínios físico (QVV) e orgânico (IDV) oferecem resultados semelhantes, contudo, o sócio-emocional do QVV evidenciou mais o impacto da alteração vocal em professores disfônicos que o IDV. O PPAV apresenta informações não contempladas nos demais protocolos.

Voice-Related Complaints in the Pediatric Population

Subjective evaluation of the voice by the patient is routinely assessed in the adult dysphonic population; this is, however, not the case in the pediatric population. There were three objectives of this study: the first goal was to study the ability of children aged 5-13 years to express themselves about physical, emotional, and sociofunctional aspects of their voice. The second goal was to explore if specific voice-related complaints were expressed by dysphonic children as compared with normophonic children. The third goal was to compare the dysphonic children's voice-related complaints with those of their mothers. The overall objective was to set the grounds for the elaboration of a standardized questionnaire in French concerning subjective evaluation of voice in children. Twenty-five dysphonic children with vocal complaint (15 nodules, one polyp, one microweb, eight unspecified) and 55 normophonic children aged 5-13 years were interviewed. The interviews were semistructured based on a canvas of voice-related questions. The dysphonic children's mothers were interviewed with the mean of a written questionnaire and were invited to discuss their answers orally with the examiner. The results were analyzed qualitatively and statistically. A Chi-square test and the Fisher's test were used to analyze the differences between the complaints expressed by the dysphonic and the normophonic children, and a binomial test was used to compare the children's answers with their mothers' answers. The qualitative analysis of the interviews suggests that children are capable of reflecting over their own voice and of giving autonomous information about different aspects of their voice. It also appeared that voice is a complex phenomenon and that it needs to be clearly and cautiously defined to the children. We identified 27 different complaints related to the voice, out of which 17 were significantly more expressed by dysphonic than by normophonic children (P<0.05). Three of the 27 identified complaints show significant discordances between the mothers and the dysphonic children. The results suggest that children are capable of making a subjective and autonomous evaluation of their voice and that dysphonic children experience significantly more voice-related discomfort than nondysphonic children. The complaints expressed by the dysphonic children and their mothers are not all in concordance. The main conclusion is that a standardized subjective evaluation of the voice, not only by the parents but also by the child him/herself, would be relevant in the assessment of pediatric dysphonia.

Measuring Quality of Life in Dysphonic Patients: A Systematic Review of Content Development in Patient-Reported Outcomes Measures

To review existing patient reported outcomes measures (PROMs) used in dysphonic populations to assess the procedures used in their development and the extent to which these meet current development standards for content generation and psychometric evaluation. The study is a systematic review. A systematic review of Medline, Cumulative Index to Nursing & Allied Health, and Health and Psychosocial Instruments databases was completed using voice, quality of life, and PROMs as keywords. We identified all patient or parent-reported questionnaires measuring quality of life associated with voice disorders from the review findings. Questionnaires were appraised for adherence to international guidelines for the development and evaluation of PROMs as outlined by the Scientific Advisory Committee of the Medical Outcome Trust. Nine PROMs fulfilled the inclusion criteria. The quality of these questionnaires was variable with regard to instrument development and none met all of the current, recommended criteria. Of the nine questionnaires, the Voice Symptom Scale underwent the most rigorous development process. Furthermore, many instruments have been augmented to allow for proxy administration, failing to address quality of life-related issues specific to the target population. Instrument development is often overlooked when attempting to quantify patient reported outcomes in dysphonic patients. Careful instrument development procedures are required to ensure that PROMs are valid, reliable, and responsive. Our review suggests that the deficits in psychometric properties of the current voice-related PROMs may be, at least in part, due to deficits in the development process. Furthermore, these data suggest the potential utility of a novel PROM adhering to rigorous international standards to better ensure that clinicians appreciate the variables most relevant to patients with voice disorders and address some of the psychometric shortcomings of the currently used questionnaires.

Listener experience and perception of voice quality

This study examines the role of listener experience with populations of voices in the perception of vocal quality. Prototype models suggest that the strategy that naive listeners use to evaluate abnormal vocal qualities will differ significantly from that of listeners experienced with dysphonic populations. Listener groups should not differ in perceptual strategy for normal voices, where their experience is equal. The nature of differences in strategy is also examined: as listeners gain experience with populations of voices, do they hear them in more complicated ways, resulting in higher dimensional multidimensional scaling solutions and/or lower r2 values for these solutions? Alternatively, does experience increase the efficiency with which listeners utilize a relatively constant set of perceptual parameters? Six naive and six experienced listeners judged the similarity of 17 dysphonic and 17 normal voices. Separate MDS solutions were found for each listener group for each voice set, and regressions compared the solutions. The relative complexity and efficiency of individual perceptual strategies are also discussed.