Dysphonic Subjects Research Articles

Deep learning in automatic detection of dysphonia: Comparing acoustic features and developing a generalizable framework.

Auditory-perceptual assessment of voice is a subjective procedure. Artificial intelligence with deep learning (DL) may improve the consistency and accessibility of this task. It is unclear how a DL model performs on different acoustic features. To develop a generalizable DL framework for identifying dysphonia using a multidimensional acoustic feature. Recordings of sustained phonations of /a/ and /i/ were retrospectively collected from a clinical database. Subjects contained 238 dysphonic and 223 vocally healthy speakers of Chinese Mandarin. All audio clips were split into multiple 1.5-s segments and normalized to the same loudness level. Mel frequency cepstral coefficients and mel-spectrogram were extracted from these standardized segments. Each set of features was used in a convolutional neural network (CNN) to perform a binary classification task. The best feature was obtained through a five-fold cross-validation on a random selection of 80% data. The resultant DL framework was tested on the remaining 20% data and a public German voice database. The performance of the DL framework was compared with those of two baseline machine-learning models. The mel-spectrogram yielded the best model performance, with a mean area under the receiver operating characteristic curve of 0.972 and an accuracy of 92% in classifying audio segments. The resultant DL framework significantly outperformed both baseline models in detecting dysphonic subjects on both test sets. The best outcomes were achieved when classifications were made based on all segments of both vowels, with 95% accuracy, 92% recall, 98% precision and 98% specificity on the Chinese test set, and 92%, 95%, 90% and 89%, respectively, on the German set. This study demonstrates the feasibility of DL for automatic detection of dysphonia. The mel-spectrogram is a preferred acoustic feature for the task. This framework may be used for vocal health screening and facilitate automatic perceptual evaluation of voice in the era of big data. What is already known on this subject Auditory-perceptual assessment is the current gold standard in clinical evaluation of voice quality, but its value may be limited by the rater's reliability and accessibility. DL is a new method of artificial intelligence that can overcome these disadvantages and promote automatic voice assessment. This study explored the feasibility of a DL approach for automatic detection of dysphonia, along with a quantitative comparison of two common sets of acoustic features. What this study adds to existing knowledge A CNN model is excellent at decoding multidimensional acoustic features, outperforming the baseline parameter-based models in identifying dysphonic voices. The first 13 mel-frequency cepstral coefficients (MFCCs) are sufficient for this task. The mel-spectrogram results in greater performance, indicating the acoustic features are presented in a more favourable way than the MFCCs to the CNN model. What are the potential or actual clinical implications of this work? DL is a feasible method for the detection of dysphonia. The current DL framework may be used for remote vocal health screening or documenting voice recovery after treatment. In future, DL models may potentially be used to perform auditory-perceptual tasks in an automatic, efficient, reliable and low-cost manner.

Segmentation of Glottal Images from High-Speed Videoendoscopy Optimized by Synchronous Acoustic Recordings.

Laryngeal high-speed videoendoscopy (LHSV) is an imaging technique offering novel visualization quality of the vibratory activity of the vocal folds. However, in most image analysis methods, the interaction of the medical personnel and access to ground truth annotations are required to achieve accurate detection of vocal folds edges. In our fully automatic method, we combine video and acoustic data that are synchronously recorded during the laryngeal endoscopy. We show that the image segmentation algorithm of the glottal area can be optimized by matching the Fourier spectra of the pre-processed video and the spectra of the acoustic recording during the phonation of sustained vowel /i:/. We verify our method on a set of LHSV recordings taken from subjects with normophonic voice and patients with voice disorders due to glottal insufficiency. We show that the computed geometric indices of the glottal area make it possible to discriminate between normal and pathologic voices. The median of the Open Quotient and Minimal Relative Glottal Area values for healthy subjects were 0.69 and 0.06, respectively, while for dysphonic subjects were 1 and 0.35, respectively. We also validate these results using independent phoniatrician experts.

Translation, Validity, and Reliability of Singing Voice Handicap Index in Persian Traditional Singers: A New Revised Version

Background: The singing voice handicap index (SVHI) was developed to assess voice-related handicaps in singers. Objectives: The purpose of this study was to evaluate the validity and reliability of a Persian translation of the SVHI (P-SVHI) for traditional Persian singers. Methods: A cross-sectional study was performed to translate and validate the P-SVHI using a "forward-backward" procedure. The questionnaire was administered to 275 traditional Persian singers (168 with a normal voice and 107 with dysphonia) ranging from 16 to 83 years. Content, construct, discriminant, convergent, and face validity, test-retest reliability, internal consistency, and floor and ceiling effects were assessed. Results: The 36-item SVHI, translated from the original English by two translators, was completed by 21 traditional Persian singers. After the face validity was approved, construct validity assessment using factor analysis identified four factors in the P-SVHI with the exclusion of seven items. The mean score of the 29-item P-SVHI on a 0 - 100 scale was 16.9 for healthy subjects and 40.9 for dysphonic subjects. Discriminant validity confirmed that P-SVHI scores were significantly different between normal and dysphonic singers, using an independent sample t-test (P < 0.001). Convergent validity was proven by strong correlations between P-SVHI scores and the Iowa Patient’s Voice Index (IPVI1, IPVI2, and "IPVI effort" scores of r = 0.58, 0.69, and 0.42, respectively, P < 0.001). Internal consistency and test-retest reliability were also excellent (Cronbach α = 0.95, average inter-item correlation = 0.40, and intra-class correlation coefficients using two-way random model with absolute agreement, ICCtwo-way random, absolute agreement = 0.69 - 0.95). No floor or ceiling effects were observed. Conclusions: The revised 29-item P-SVHI is a valid and reliable tool in differentiating normal and dysphonic Persian traditional singers.

Fadiga vocal e fatores associados em professores universitários em ensino remoto

ABSTRACT Purpose To verify the self-perception of vocal fatigue and associated factors in university professors in remote teaching during the COVID-19 pandemic. Methods Cross-sectional, observational, descriptive and analytical study, with a remote approach with university professors in teaching during the COVID-19 pandemic. After acceptance, the participants answered a sociodemographic questionnaire, the Vocal Signs and Symptoms Questionnaire, Vocal Fatigue Index Protocol and Vocal Handicap Index 10. The analysis of the data identified through descriptive and initial statistics, using the given Chi-square and Mann-Whitney tests. Associations between qualitative variables were verified using chi-square and Fisher's exact tests. The IFV and IDV-10 means were verified with the number of signs and symptoms using the Mann-Whiney test. Results Sample of 91 teachers, mostly female (83.5%), and mean age of 44.0 years. Teachers had an average of 3.8 signs and symptoms and the total core of the IFV indicated the presence of vocal risk, with values considered for dysphonic subjects. Teachers don't want vocals. Conclusion University professors in remote teaching self-assessed being at risk for vocal fatigue. Among the factors associated with IFV, professors who presented more than two vocal signs and symptoms had a greater sensation of vocal fatigue. No self-perception of voice handicap was observed, however, those who had more than two vocal signs and symptoms had worse self-perception of voice handicap.

Intersegmenter Variability in High-Speed Laryngoscopy-Based Glottal Area Waveform Measures.

High-speed videoendoscopy (HSV) has potential to objectively quantify vibratory vocal fold characteristics during phonation. Glottal Analysis Tools (GAT) version 2018, developed in Erlangen, Germany, is software for determining various glottal area waveform (GAW) quantities. Before having GAT analyze HSV videos, segmenters have to define glottis manually across videos in a semiautomatic segmentation protocol. Such interventions are hypothesized to induce variability of subsequent GAW measure computation across segmenters and may attenuate GAT measures' reliability to a certain point. This study explored intersegmenter variability in GAT's GAW measures based on semiautomatic image processing. Cohort study of rater reliability. In total, 20 HSV videos from normophonic and dysphonic subjects with various laryngeal disorders were selected for this study and segmented by three trained segmenters. They separately segmented glottis areas in the same frame sets of the videos. Upon analysis of GAW, GAT offers 46 measures related to topologic GAW dynamic characteristics, GAW periodicity and perturbation characteristics, and GAW harmonic components. To address GAT's reliability, intersegmenter-based variability in these measures was examined with intraclass correlation coefficient (ICC). In general, ICC behavior of the 46 GAW measures across three raters was highly acceptable. ICC of one parameter was moderate (0.5 < ICC < 0.75), good for seven parameters (0.75 < ICC < 0.9), and excellent for 38 parameters (0.9 < ICC). Overall, high ICC values confirm clinical applicability of GAT for objective and quantitative assessment of HSV. Small intersegmenter differences with actual small parameter differences suggest that manual or semiautomatic segmentation in GAT does not noticeably influence clinical assessment outcome. To guarantee the software's performance, we suggest segmentation training before clinical application. 2b Laryngoscope, 130:E654-E661, 2020.

A Case of Specificity: How Does the Acoustic Voice Quality Index Perform in Normophonic Subjects?

The acoustic voice quality index (AVQI) is a multiparametric tool based on six acoustic measurements to quantify overall voice quality in an objective manner, with the smoothed version of the cepstral peak prominence (CPPS) as its main contributor. In the last decade, many studies demonstrated its robust diagnostic accuracy and high sensitivity to voice changes across voice therapy in different languages. The aim of the present study was to provide information regarding AVQI’s and CPPS’s performance in normophonic non-treatment-seeking subjects, since these data are still scarce; concatenated voice samples, consisting of sustained vowel phonation and continuous speech, from 123 subjects (72 females, 51 males; between 20 and 60 years old) without vocally relevant complaints were evaluated by three raters and run in AVQI v.02.06. According to this auditory-perceptual evaluation, two cohorts were set up (normophonia versus slight perceived dysphonia). First, gender effects were investigated. Secondly, between-cohort differences in AVQI and CPPS were investigated. Thirdly, with the number of judges giving G = 1 to partition three sub-levels of slight hoarseness as an independent factor, differences in AVQI and CPPS across these sub-levels were investigated; for AVQI, no significant gender effect was found, whereas, for CPPS, significant trends were observed. For both AVQI and CPPS, no significant differences were found between normophonic and slightly dysphonic subjects. For AVQI, however, this difference did approach significance; these findings emphasize the need for a normative study with a greater sample size and subsequently greater statistical power to detect possible significant effects and differences.

The Turkish Version of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V): A Reliability and Validity Study

The Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) was developed to assess voice quality. The aim of this study was to develop a Turkish adaptation of CAPE-V and to evaluate the reliability and validity of the Turkish version. To adapt the CAPE-V protocol to Turkish, six sentences were constructed to meet the phonetic requirements. The validity of the Turkish version of the CAPE-V was tested with inter-rater reliability, intrarater reliability, and GRBAS versus the CAPE-V judgments. Ninety-nine dysphonic and 83 healthy subjects were enrolled. High inter-rater and intrarater reliability (ICC > 0.88, r > 0.81, respectively) were obtained for all vocal parameters. The differences in the six CAPE-V parameters between healthy and dysphonic subjects were statistically significant (P < 0.0001). The correlations between CAPE-V and GRBAS scales were high in overall severity-grade and roughness parameters (r = 0.85, r = 0.82, respectively), the lowest correlation was the strain parameter (r = 0.66). The Turkish version of CAPE-V is a reliable and valid instrument for auditory-perceptual evaluation of the Turkish speaking population.

Immediate Effects of the Semi-Occluded Ventilation Mask on Subjects Diagnosed With Functional Dysphonia and Subjects With Normal Voices

The present study was designed to assess the immediate effects of the semi-occluded ventilation mask (SOVM) in subjects with functional dysphonia and subjects with normal voice. Sixty-four participants were included in this study (48 women and 16 men). Thirty-one of them were diagnosed with functional dysphonia and 33 with normal voice. All subjects were randomly assigned to one of two conditions: an experimental condition using the SOVM (n = 33) and a control condition with participants not using the SOVM (n = 31). Thus, within both conditions, participants could be either dysphonic or normal-voiced. This produced a total of four different groups: (1) subjects with normal voice with SOVM (n = 17), (2) subjects with normal voice without SOVM (n = 16), (3) dysphonic subjects with SOVM (n = 16), and (4) dysphonic subjects without SOVM (n = 15). All participants underwent aerodynamic, electroglottographic (EGG), and acoustic assessments, and were also asked to assess their own voice, before and after voice exercises. Significant differences were found for aerodynamic, EGG, and acoustic variables when comparing SOVM conditions (dysphonic and normal) against control. Cepstral peak prominence and EGG contact quotient showed an increase among dysphonic participants with SOVM. L1-L0 showed an increase for all participants in SOVM condition (dysphonic and normal). Self-perceived resonant voice quality showed an increase for both groups in SOVM condition. Glottal airflow showed a decrease for the dysphonic participants in SOVM condition. Phonation threshold pressure and subglottic pressure showed a decrease for both groups in SOVM condition. The present study suggests that immediate positive effect could be produced by connected speech phonatory tasks using the SOVM in both dysphonic subjects and subjects with normal voice, the change being greater among the former. SOVM seems to promote an easy voice production and a more efficient phonation.

Effectiveness of Recurrence Quantification Measures in Discriminating Subjects With and Without Voice Disorders

The objective of this study was to analyze the accuracy of recurrence quantification measurements (RQMs) in discriminating between individuals with and without voice disorders. This study consisted of a total of 541 recorded voice samples from normal and dysphonic subjects. All subjects recorded a sustained vowel /Ɛ/ and underwent a laryngoscopic examination of the larynx. Twelve RQMs and three parameters related to the topology of the phonatory system were extracted from the samples, for a total of 15 measures. The classification used quadratic discriminant analysis and includes the measures of accuracy, sensitivity, and specificity. Single measurements such as Shannon's entropy, average diagonal length, and transitivity had only acceptable performance ratings (≥70%) in discriminating between individuals with and without voice disorders. The combination of the parameters average diagonal length, Shannon's entropy, trapping time, length of the longest vertical line, tau, imbedding dimension, neighborhood radius, and transitivity produced the highest accuracy in discrimination (83.27%). Therefore, the performance of RQMs related to the formation of diagonal lines in classifying individuals with and without voice disorders was acceptable at ≥70%. A combination of RQMs showed good performance in discriminating between the study groups, with higher sensitivity and specificity.

Preliminary study of Novafon local vibration voice therapy for dysphonia treatment

Background: The objective of this study was to explore the effectiveness of a five-week Novafon local vibration voice therapy (NLVVT) program for dysphonia treatment.Methods: Eleven dysphonic subjects participated in this specific program.Results: Treatment effects were assessed during (i.e. weekly) and after NLVVT. Large and significant treatment effects were revealed in acoustics (i.e. spectrography), and multiparametric indices (i.e. Acoustic Voice Quality Index (AVQI), and Dysphonia Severity Index (DSI)) during and after NLVVT (all p values < .01). Additionally, self-evaluation (i.e. Voice Handicap Index (VHI)) showed a significant improvement after NLVVT (p < .01). Gender independent voice range profile parameters (i.e. acoustics) only showed significant effects after treatment (p ≤ .01), but not during the treatment. Finally, aerodynamic measurement (i.e. phonation quotient) showed low treatment effects after NLVVT, which were not significant (p > .05).Conclusions: The preliminary results showed that NLVVT might be successful in voice treatment. Large treatment effects might be expected in AVQI, DSI, spectrography and VHI after using NLVVT. Other voice characteristics showed smaller treatment effects (i.e. voice range profile parameters) or no meaningful treatment effects (i.e. phonation quotient).

Screening value of V-RQOL in the evaluation of occupational voice disorders.

Given the growing number of occupational voice users, easy and quick broad-scale screening is necessary to provide prophylaxis of voice disorders. The aim of the study was to assess applicability of the Voice Related Quality of Life questionnaire (V-RQOL) to screening occupational voice disorders. The research comprised 284 subjects divided into 3 groups: 0 - the control group of normophonic subjects, non-professional voice users (N = 60), 1 - occupational voice users with objectively confirmed voice disorders (N = 124), 2 - the non-randomized group of occupational voice users with and without voice problems (N = 100). Self-assessment of voice was performed by means of the V-RQOL in comparison to the Voice Handicap Index (VHI). The relation between the V-RQOL and VHI was determined by means of linear regression. Receiver Operating Characteristic (ROC) curves were constructed and the cut-off point of the VRQOL was determined to discriminate between normophonic and dysphonic subjects. The relationship between the VHI and V-RQOL scores indicated a satisfactory coefficient of determination: R2 = 0.7266. High values of Cronbach's α confirmed high reliability of the V-RQOL test (0.867). Voice-Related Quality of Life questionnaire (V-RQOL) results were significantly worse in the study group than for normophonic controls (p < 0.001). The cut-off point for the test was set at 79 points. The determined area under the curve (AUC) = 0.910 (p < 0.001) showed high diagnostic accuracy of the V-RQOL. Results of the VRQOL differed for diagnose-based subgroups of dysphonic patients. The study gives grounds for application of the V-RQOL as a reliable tool for screening occupational voice disorders. Med Pr 2018;69(2):119-128.

Musculoskeletal Pain and Voice-related Quality of Life in Dysphonic and Non-dysphonic Subjects

This study aimed to compare and correlate musculoskeletal pain and voice-related quality of life of dysphonic and non-dysphonic individuals. This is a retrospective case-control study. A total of 74 adults were divided into two groups: the experimental group (EG) comprising 37 individuals with vocal complaints and hyperfunctional dysphonia, and the control group (CG) comprising 37 individuals without vocal complaints and with healthy voices. Both groups presented similar gender and age (28 females and 9 males for each group; average age = 31.5). All the participants answered the protocols: Voice-Related Quality of Life and Musculoskeletal Pain Questionnaire. Statistical data were analyzed by Mann-Whitney U test (P ≤ 0.05) and Spearman correlation test (P ≤ 0.05). It was observed that the EG presented significantly lower scores of voice-related quality of life in the social-emotional (P < 0.001), physical (P < 0.001), and total (P < 0.001) fields. Concerning musculoskeletal pain, it was observed in the EG that there was a higher intensity in pain in the region of the larynx (P < 0.001), and a higher frequency of pain in the submandibular (P = 0.013), larynx (P < 0.001), and front of the neck (P = 0.002) regions, when compared with the CG. In the group of individuals studied, worst indexes of voice-related quality of life and higher frequency and intensity of pain in the larynx were observed, in addition to higher frequency of pain in regions near the larynx in dysphonic subjects. There was correlation between voice-related quality of life and the frequency and intensity of musculoskeletal pain.

Relative fundamental frequency of voiced and voiceless stops and fricatives for different phonation types in normal French speakers

The relative fundamental frequency (RFF) was recently used to assess vocal effort in normal and dysphonic subjects since it reflects the vocal fold tension at the offset and onset of vowels with, in particular, lower values at the edges of voiced consonants compared to their voiceless counterparts. In this study, we explored the RFF variations according to the voicing status and the articulation manner of consonants, in several types of speech production known to involve different levels of vocal effort. Twelve native French speakers (6 females) with normal voice were asked to produce 24 trains of eight syllables in seven vocal conditions: spontaneous, low, high, soft, loud, breathy, and pressed voice. We considered the unaspirated voiceless and voiced consonants /p, b, f, v/ with the middle open vowel /a/. As expected, the RFF was lower for voiced than for voiceless consonants. In addition, it was lower for stops than for fricatives. The RFF was also lower for the high, loud, and pressed conditions while it was higher for the low, soft, and breathy conditions in comparison to the values for the spontaneous voice. The RFF measurement seems to be efficient to discern subtle levels of vocal effort in normal subjects.

Towards Objective Voice Assessment: The Diplophonia Diagram

Diplophonia is an often misinterpreted symptom of disordered voice, and needs objectification. An audio signal processing algorithm for the detection of diplophonia is proposed. Diplophonia is produced by two distinct oscillators, which yield a profound physiological interpretation. The algorithm's performance is compared with the clinical standard parameter degree of subharmonics (DSH). This is a prospective study. A total of 50 dysphonic subjects with (28 with diplophonia and 22 without diplophonia) and 30 subjects with euphonia were included in the study. From each subject, up to five sustained phonations were recorded during rigid telescopic high-speed video laryngoscopy. A total of 185 phonations were split up into 285 analysis segments of homogeneous voice qualities. In accordance to the clinical group allocation, the considered segmental voice qualities were (1) diplophonic, (2) dysphonic without diplophonia, and (3) euphonic. The Diplophonia Diagram is a scatter plot that relates the one-oscillator synthesis quality (SQ1) to the two-oscillator synthesis quality (SQ2). Multinomial logistic regression is used to distinguish between diplophonic and nondiplophonic segments. Diplophonic segments can be well distinguished from nondiplophonic segments in the Diplophonia Diagram because two-oscillator synthesis is more appropriate for imitating diplophonic signals than one-oscillator synthesis. The detection of diplophonia using the Diplophonia Diagram clearly outperforms the DSH by means of positive likelihood ratios (56.8 versus 3.6). The diagnostic accuracy of the newly proposed method for detecting diplophonia is superior to the DSH approach, which should be taken into account for future clinical and scientific work.

Is perceived dysphonia related to perceived healthiness?

Literature has shown that voice-disordered persons are at higher risk for negative attitudes on several personality and physical appearance traits than vocally normal persons. This study investigated general perceptions of health in subjects with various degrees of dysphonia. Recordings from 100 normophonic and dysphonic subjects were auditorily rated on dysphonia severity by five experienced clinicians and on degree of healthiness/unhealthiness by seven unexperienced listeners. Results revealed strong correlation between auditory ratings of dysphonia severity and unhealthiness severity. Dysphonic subjects are rated significantly unhealthier than normophonic subjects, and the receiver-operating characteristics curve showed that even slight dysphonia induces negative attributions of unhealthiness. This study provides additional evidence for the negative attitudes with which dysphonic speakers are confronted, especially in terms of health.

Speech Tasks and Interrater Reliability in Perceptual Voice Evaluation

The optimal selection of speech task is essential for more reliable perceptual ratings and a better understanding of the perceptual qualities of pathologic voices. Nevertheless, researchers have rarely explored this issue using the GRBAS scale. This study investigates the effect of speech task selection on interrater reliability during perceptual voice assessment. Experimental study. Sixty subjects, 39 dysphonic subjects and 21 normal controls, performed 13 speech tasks including three 5-second sustained vowel sounds (/ɑ/, /i/, and /u/) each at three pitch levels (high, habitual, and low), maximum phonation of the vowel /ɑ/, pitch glide, counting from 1 to 10, and oral reading of the Rainbow Passage. A group of 18 graduate students in speech-language pathology served as perceptual judges and rated the dysphonic severity for the speech samples based on three parameters in the GRBAS scale-Grade, Roughness, and Breathiness. The formalism of the AC1 statistic proposed by Gwet was applied to determine relative reliability between the speech tasks and the raters. The counting task and sustained vowel /ɑ/ in high, habitual, and low registers exhibited the most reproducibility and consequently the highest reliability statistic. The counting task and sustained /ɑ/ phonation are the optimal tasks for perceptual voice judgment in regard to interrater reliability. Future perceptional studies may benefit from this finding to determine the relationship between speech task selection and the validity of any given perceptual rating system in terms of sensitivity and specificity.

Voice disorders assessed by (cross-) Sample Entropy of electroglottogram and microphone signals

The quantitative analysis of vocal disorders by nonlinear signal processing methods has been extensively used in the last two decades. In this work, two algorithms for nonlinear time-series analysis, Sample Entropy and cross-Sample Entropy, are used on electroglottogram (EGG) and microphone (MIC) signals recorded from 51 normal and 80 dysphonic subjects, to obtain summary measures of voice disorders through SampEn and cross-SampEn indices. Such parameters quantify, respectively, the degree of irregularity (in the sense of self-dissimilarity) within a time-series and of asynchrony (in the sense of cross-dissimilarity) between two distinct time-series. The aims of this work are: to determine if statistically significant differences in terms of signal irregularity quantified by SampEn occur between normal and pathological subjects, investigating whether or not such differences can be equally seen in EGG and MIC; to assess if cross-SampEn reveals different degrees of asynchrony between EGG and MIC signals in the two groups. Results show that SampEn in pathological subjects is higher than in normal subjects for both EGG and MIC time-series, with a statistically significant difference detectable from both signals (Pe<10−4 for EGG and Pe<10−7 for MIC). Cross-SampEn exhibits a statistically significant difference too, showing a higher degree of cross-dissimilarity between EGG and MIC time-series for pathological subjects (Pe<10−4). In conclusion, SampEn and cross-SampEn well quantify the increase of complexity of both EGG and MIC signals and the decrease of their cross-similarity in presence of vocal disorders. Thanks to the complementarity of nonlinear indicators to the traditionally considered linear ones, SampEn and cross-SampEn appear as suitable candidates to enter the pool of approaches to investigate speech pathologies and to obtain potentially new insights on their nature.

Arabic abbreviated version of pediatric voice handicap index (Preliminary study)

Background and Objectives: The Pediatric Voice Handicap Index (VHI) is a valid tool for assessing self-perceived voice handicap in children. We developed an Arabic abbreviated version of pediatric Voice Handicap Index (pVHI) for future use in Arab pediatric population. Setting and Design: The study was conducted on nondysphonic children at King Abdul-Aziz University Hospital, Riyadh, Saudi Arabia. Subjects and Methods: The original English pediatric VHI which is composed of 23-items was shortened to 10-items and translated into Arabic by a committee of two Pediatric Otolaryngologists and one Phoniatrician. The translated Arabic version was administered to the parents of 137 children without voice disorders or communication disorders. Results: The subjects of our study had low scores which were comparable with control groups of different worldwide pediatric VHI studies. Also, there was an insignificant effect of gender on VHI subscales (P > 0.025). Obviously, the validity of these results may be limited by the absence of another dysphonic group. However, the preliminary results have encouraged us to report it and when a dysphonic group is available it will be possible to better validate this pVHI in term of performance. Conclusion: Arabic version of the pVHI is a valuable tool for voice specialists dealing with Arabic speaking children. Future testing of our developed Arabic abbreviated pVHI with dysphonic groups to confirm its reliability in differentiating control subjects from dysphonic subjects is recommended.

Efectos acústicos inmediatos de una secuencia de ejercicios vocales con tubos de resonancia

OBJETIVO: el propósito de este estudio es conocer el efecto acústico inmediato de una secuencia de ejercicios fonatorios utilizando tubos de resonancia en un grupo de sujetos disfónicos. MÉTODO: se aplicó una secuencia única de cuatro tareas fonatorias dentro de tubos de resonancia a veinticuatro profesores con voces disfónicas, evaluadas perceptualmente con la escala GRBAS. Las muestras de voz fueron grabadas antes y después de la secuencia de ejercicios. El análisis acústico incluyó Cepstrum, Jitter, Shimmer y relación armónico-ruido (NHR). Se solitó completar un protocolo de autovaloración vocal posterior a la secuencia de ejercicios para evaluar los efectos subjetivos. Se compararon los valores de los parámetros acústicos en las muestras pre y post entrenamiento. RESULTADOS: cambios significativos fueron obtenidos en el análisis Cepstral, Jitter y relación armónico-ruido. En la autovaloración, los efectos positivos predominaron sobre los negativos, siendo los principales: voz más estable, voz más clara y garganta más abierta. CONCLUSIÓN: el uso de tareas fonatorias dentro de tubos de resonancia puede tener un efecto fisiológico terapéutico inmediato en sujetos con voces disfónicas y una percepción subjetiva de mejoría en la producción de la voz posterior a la terapia.

Assessment of dysphonia due to benign vocal fold lesions by acoustic and aerodynamic indices: a multivariate analysis

The goal was to identify acoustic and aerodynamic indices that allow the discrimination of a benign organic dysphonic voice from a normal voice. Fifty-three patients affected by dysphonia caused by vocal folds benign lesions, and a control group were subjected to maximum phonation time (MPT) measurements, GRB perceptual evaluations and acoustic/aerodynamic tests. All analyzed variables except the airflow variation coefficient were significantly different between the two groups. The unique significant factors in the discrimination between healthy and dysphonic subjects were the aerodynamic indices of MPT and Glottal efficiency index, and the acoustic index Shimmer. These results show that a combination of three parameters can discriminate a voice deviance and highlight the importance of a multidimensional assessment for objective voice evaluation.