Grade, Roughness, Breathiness, Asthenia And Strain Scale Research Articles

Evaluation of the Effectiveness of Resonant Voice Therapy in Patients with Functional Voice Disorder

This study aims to determine the effectiveness of resonant voice therapy (RVT) in patients with functional voice disorder and to examine the subjective and objective voice changes after the therapy. This study adopted an experimental research design with a pretest-posttest control group. Thirty-four women participated in the study-17 in the experimental group and 17 in the control group. Voice hygiene training and RVT were applied to the experimental group. The Turkish version of the Voice Handicap Index (VHI-10) and GRBAS (Grade, Roughness, Breathiness, Asthenia, and Strain)scale were used for subjective voice assessment. Voice recordings were subjected to acoustic analysis on the PRAAT program. After an 8-week therapy program, the same process was repeated for post-test assessment. In the voice analyses performed after RVT, which was applied to patients with functional voice disorders, the results of the acoustic analysis showed statistically significant differences in jitter, PPQ5, RAP, shimmer, APQ11, and NHR parameters. Subjective voice analysis indicated a statistically significant decrease in VHI-10 scores from 20.88±5.33-9.06±3.3 in the experimental group. The GRBAS score was 4.29±1.2 before the therapy and 1.71±1.1 after the therapy, which is a statistically significant decrease. The results point out that RVT has been effective in improving the objective and subjective parameters of patients with functional voice disorders. RVT applied to patients with functional voice disorders provides significant improvement in acoustic and perceptual voice parameters. The RVT is an effective therapy method in the treatment of patients with functional voice disorders and should be considered as a therapeutic option.

Analysis of the Outcomes of Immediate Recurrent Laryngeal Nerve Reconstruction During Thyroid Surgery for Prevention of Vocal Fold Paralysis

Recurrent laryngeal nerve (RLN) injury and the resulting paralysis is the most common and known complicationof thyroid surgery. Several surgical techniques, such as medialization thyroplasty with or without arytenoid adduction and injection laryngoplasty, have been developed to treat RLN injury, but these procedures have specific limitations and complications. In this study, we present the outcomes for our patients who underwent immediate RLN reconstruction during thyroid surgery by analyzing both subjective and objective outcomes. A retrospective study was conducted for patients who underwent total or subtotal thyroidectomy between May 2012 and March 2020. Among them, patients who underwent immediate RLN reconstruction due to unilateral RLN injury were followed for at least 12 months. The voice perceptual evaluation, acoustic analysis, voice range profile, and Voice Handicap Index (VHI) scores were obtained preoperatively, 1 month, 6 months, and 12 months after surgery. Among the 11 patients, 6 patients (54.5%) underwent direct anastomosis, and 5 patients (45.5%) underwent nerve grafts using ansa cervicalis and great auricular nerve. The grade and breathiness in the GRBAS (grade, roughness, breathiness, asthenia, and strain) scale and jitter item showed significant improvement at 12 months postoperatively, and although not statistically significant, the rest of the items also tended to improve. The total, functional, and physical scores on VHI improved significantly at 12 months postoperatively. Moreover, when comparing the voice analysis of the direct anastomosis group and the nerve graft group, there was no significant difference between the groups in objective and subjective results. Immediate RLN reconstruction demonstrated significant voice improvement postoperatively, and reconstructing the nerve immediately and combining follow-up treatment in the event of RLN injury will greatly help patients improve their long-term voice outcomes.

Efficacy of voice therapy in the treatment of mutational falsetto

Objectives: This study aimed to evaluate the effectiveness of voice therapy in patients with mutational falsetto with objective and subjective methods. Patients and Methods: In this retrospective study, 18 male patients (mean age: 17.2±3.7 years; range, 14 to 26 years) diagnosed with mutational falsetto underwent acoustical analysis between May 2020 and January 2023 using Praat software. For objective acoustic analyses, fundamental frequency, jitter, shimmer, and maximum phonation time parameters were used. For subjective analyses, the GRBAS (Grade, Roughness, Breathiness, Asthenia and Strain) scale and the voice handicap index were used. Pre- and post-voice therapy subjective and objective parameters were compared. Results: The mean pre-voice therapy fundamental frequency value of the patients was 183.63±22.18 Hz, while the post-therapy value was 125.03±15.52 Hz. The mean pre-voice therapy voice handicap index score of the patients was 30.33±3.67, whereas the post-therapy score was 9.77±2.48. While the GRBAS scale value of the patients was 7.38±1.24, post therapy score was 1.55±1.29. As a result of the comparison of the objective and subjective values before and after the therapy, a statistically significant difference was found (p<0.001). Conclusion: Mutational falsetto can be treated with the use of inexpensive sound analysis programs that do not require special hardware in clinical practice and with sound therapy methods.

Real-Time Light-Guided Vocal Fold Injection via the Cricothyroid Membrane in Unilateral Vocal Fold Paralysis: A Human Pilot Study.

Objectives. Vocal fold injection (VFI) via the cricothyroid (CT) membrane is used to treat various diseases affecting the vocal folds. The technical challenges of this technique are mainly related to the invisibility of the needle. Real-time light-guided VFI (RL-VFI) was recently developed for injection under simultaneous light guidance in the CT approach. Herein, we present the first clinical trial of RL-VFI, in which we investigated the feasibility and safety of this new technique in unilateral vocal fold paralysis (VFP).Methods. This prospective pilot study enrolled 40 patients, who were treated with RL-VFI for unilateral VFP between September 2020 and August 2021. Adverse events were monitored during the procedure and for 4 weeks postoperatively. The Voice Handicap Index-10, the GRBAS (grade, roughness, breathiness, asthenia, and strain) scale, aerodynamic studies, and acoustic analyses were evaluated to compare the voice improvement after 4 weeks with the baseline values.Results. The needle tip was intuitively identified by the red light. The mean procedure time was 95.6±40.6 seconds for the initial injection, while the additional injection required 79.2±70.5 seconds. The injection was performed under light guidance without additional manipulation after the needle reached the intended point. No acute or delayed adverse events were reported. Among the 40 patients, 36 completed voice analyses after 4 weeks. Subjective and objective voice parameters, including the Voice Handicap Index-10, GRBAS scale, maximum phonation time, mean expiratory airflow, fundamental frequency, jitter, shimmer, and noise-to-harmonics ratio improved significantly after RL-VFI (P<0.05), while the expiratory volume was maintained.Conclusion. RL-VFI is feasible and safe for treating patients with unilateral VFP. This technique is anticipated to improve the precision and safety of the CT approach in the treatment of unilateral VFP. This study provides a rationale for further structured clinical studies.

Surgical interventions for pediatric unilateral vocal fold paralysis: A systematic review and meta-analysis

ObjectiveTo evaluate outcomes of injection laryngoplasty (IL) and laryngeal reinnervation for the treatment of pediatric Unilateral Vocal Fold Paralysis (UVFP), especially on swallowing and quality of voice. MethodsA literature review was performed in Medline/PubMed and Cochrane Library, following PRISMA guidelines, with no constraints on publication date. We included studies in English, Portuguese or Spanish about surgical treatment for UVFP on the pediatric population (0–21 years) that documented outcomes for one of the following techniques: IL or laryngeal reinnervation. Study characteristics, patient demographics, technical aspects of each procedure, complications, and outcomes for voice and swallowing were extracted. A meta-analysis with inverse variance, random-effects model was performed. ResultsThe PRISMA approach yielded 22 studies, totaling 267 patients. Seven reinnervation articles were included in meta-analysis for maximum phonation time (MPT) and quality of voice measured by Grade, Roughness, Breathiness, Asthenia and Strain (GRBAS) scale. Cardiac surgery had caused UVFP in 62.8% (142/226) of the cases. The main indication for IL was aspiration and for reinnervation was dysphonia. For IL, there was an improvement of 84.5% (confidence interval [CI] 82.6–88.4%) in swallowing and 81.4% (CI 74.6–88.1%) in voice. For reinnervation, there was an improvement of 91.6% (CI 88.2–94.9%) in swallowing and 96.8% (CI 95.5–98.0%) in voice. We found an increase of 6.19 s (CI 1.00 to 11.38) in MPT and a mean difference in GRBAS sum of −3.53 points (CI -6.15 to −0.91) after reinnervation. ConclusionRetrospective cohort studies suggest that injection laryngoplasty and reinnervation are both effective in improving swallowing and voice in children with UVFP. There was clinical evidence of improvement in the MPT and GRBAS scale meta-analysis in patients undergoing reinnervation.

Cultural and Linguistic Adaptation of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) Into Hindi.

Aim The purpose of this study was to develop and assess the reliability of a Hindi version of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V). Reliability was assessed by comparing Hindi CAPE-V ratings with English CAPE-V ratings and by the Grade, Roughness, Breathiness, Asthenia and Strain (GRBAS) scale. Method Hindi sentences were created to match the phonemic load of the corresponding English CAPE-V sentences. The Hindi sentences were adapted for linguistic content. The original English and adapted Hindi CAPE-V and GRBAS were completed for 33 bilingual individuals with normal voice quality. Additionally, the Hindi CAPE-V and GRBAS were completed for 13 Hindi speakers with disordered voice quality. The agreement of CAPE-V ratings was assessed between language versions, GRBAS ratings, and two rater pairs (three raters in total). Pearson product-moment correlation was completed for all comparisons. Results A strong correlation (r > .8, p < .01) was found between the Hindi CAPE-V scores and the English CAPE-V scores for most variables in normal voice participants. A weak correlation was found for the variable of strain (r < .2, p = .400) in the normative group. A strong correlation (r > .6, p < .01) was found between the overall severity/grade, roughness, and breathiness scores in the GRBAS scale and the CAPE-V scale in normal and disordered voice samples. Significant interrater reliability (r > .75) was present in overall severity and breathiness. Conclusions The Hindi version of the CAPE-V demonstrates good interrater reliability and concurrent validity with the English CAPE-V and the GRBAS. The Hindi CAPE-V can be used for the auditory-perceptual voice assessment of Hindi speakers.

Voice Component Relationships with High Reflux Symptom Index Scores in Muscle Tension Dysphonia.

To analyze the Reflux Symptom Index (RSI) and the Voice-Related Quality of Life (V-RQOL) scores based on the perceptual and analytical parameters in primary MTD patients with no reflux. Cross-sectional study. One hundred and eighteen participants, that is, sixty patients with normal voices and fifty-eight patients with primary MTD were recruited in this study. The diagnosis of primary MTD was made by perceptual voice analysis, neck palpation, video-laryngoscopic examination, and exclusion of other etiologies. Acoustic analysis and the GRBAS (Grade, Roughness, Breathiness, Asthenia, and Strain) scale were evaluated for all participants. The V-RQOL and RSI questionnaires were then given to all participants. This study included 118 participants of 29 males (48.3%) and 31 females (51.7%) in the normal group. MTD group also included 27 males (46.6%) and 31 (53.4%) female patients. Mean (SD) RSI and V-RQOL scores were 12.35 (3.84) and 11.09 (2.20) for the normal group, and 22.87 (6.97) and 22.89 (7.94) for the MTD group (P = .000). In the MTD group, V-RQOL had a positive correlation with jitter for /i/ and /u/, Noise to Harmonic Ratio (NHR) for /i/, /a/, and /u/, and Grade, Roughness, and Strain of GRBAS scale (P < .05). In addition, RSI had a positive correlation with Strain in the MTD group (P < .05). MTD patients in the absence of laryngopharyngeal reflux findings may have high RSI scores. Hence, patients with high RSI scores and disproportionate acoustic and perceptual analysis would require a thorough evaluation of MTD. 4 Laryngoscope, 131:E1573-E1579, 2021.

A Comparison of Grade, Roughness, Breathiness, Asthenia, and Strain Ratings of Vocal Music Students and Communication Disorders Students

Purpose The GRBAS (Grade, Roughness, Breathiness, Asthenia, and Strain; Hirano, 1981) scale was used to determine if there was a difference in how vocal music (VM) students and communication disord...

Contralateral Vocal Fold Reactive Lesions

Contralateral reactive lesions (RLs) represent a distinct entity among benign bilateral vocal fold (VF) lesions. Lack of uniform nomenclature and a myriad of surgical options have hampered attempts to develop treatment guidelines. The objective of this study is to better define RLs and their prognosis, through the development of a standard nomenclature, with an aim to guide treatment and delineate the role of phonosurgery. Case series with chart review. Tertiary care center. Analysis was performed on patients with Current Procedural Terminology code 31545. Operative reports with a primary lesion and contralateral RL were included. Outcomes included the Voice Handicap Index-10 (VHI-10) and GRBAS (grade, roughness, breathiness, asthenia, and strain) scale, lesion persistence/recurrence, mucosal wave, and edge character based on blinded videostroboscopy review. A nomenclature was developed based on intraoperative RLs (n = 30), defined by lesion consistency (fibrous or polypoid) and relationship to normal VF edge (gradual or steep). Reactive lesion treatment included no intervention, excision, potassium titanyl phosphate laser, steroid injection, or a combination thereof. Observations included the following: inconsistent treatment modalities were employed, excision of RLs did not yield better outcomes, fibrous RLs were more likely to persist and polypoid lesions more likely to recur, gradual lesions were more likely to remain disease free, and most treatments showed improved mucosal wave, VHI-10, and GRBAS. Reactive lesions have not been well classified, and treatments are based on subjective intraoperative decision making with unpredictable outcomes. The nomenclature proposed will allow for a better definition of the RL and provide a framework for future research to identify optimal treatment.

Effect of Laryngopharyngeal Neuromuscular Electrical Stimulation on Dysphonia Accompanied by Dysphagia in Post-stroke and Traumatic Brain Injury Patients: A Pilot Study.

ObjectiveTo investigate the effect of laryngopharyngeal neuromuscular electrical stimulation (NMES) on dysphonia in patients with dysphagia caused by stroke or traumatic brain injury (TBI).MethodsEighteen patients participated in this study. The subjects were divided into NMES (n=12) and conventional swallowing training only (CST, n=6) groups. The NMES group received NMES combined with CST for 2 weeks, followed by CST without NMES for the next 2 weeks. The CST group received only CST for 4 weeks. All of the patients were evaluated before and at 2 and 4 weeks into the study. The outcome measurements included perceptual, acoustic and aerodynamic analyses. The correlation between dysphonia and swallowing function was also investigated.ResultsThere were significant differences in the GRBAS (grade, roughness, breathiness, asthenia and strain scale) total score and sound pressure level (SPL) between the two groups over time. The NMES relative to the CST group showed significant improvements in total GRBAS score and SPL at 2 weeks, though no inter-group differences were evident at 4 weeks. The improvement of the total GRBAS scores at 2 weeks was positively correlated with the improved pharyngeal phase scores on the functional dysphagia scale at 2 weeks.ConclusionThe results demonstrate that laryngopharyngeal NMES in post-stroke or TBI patients with dysphonia can have promising effects on phonation. Therefore, laryngopharyngeal NMES may be considered as an additional treatment option for dysphonia accompanied by dysphagia after stroke or TBI.

Role of Voice Therapy in Patients with Mutational Falsetto

ABSTRACT Background Mutational falsetto is the most common mutational voice disorder, found in all ages. Clinicians often miss this diagnosis due to unfamiliarity with the condition. The voice of a person with mutational falsetto is high pitched, weak, thin, breathy, hoarse and monopitched. Objective This study was carried out to evaluate the efficacy of voice therapy in persons with mutational falsetto. Methods Eleven male patients with ages between 18 and 26 years (mean age 22.18 years, SD 2.52) diagnosed with mutational falsetto underwent acoustical analysis using Praat Software, perceptual analysis using grade, roughness, breathiness, asthenia and strain (GRBAS) scale and psychosocial analysis using emotional component of voice handicap index (VHI). All the components were analyzed pre- and postvoice therapy. Results Improvement in acoustic analysis parameters was statistically significant with p-value less than 0.0001(pretherapy mean of fundamental frequency (F0) was 217.45 with SD 8.68, whereas post-therapy mean of F0 was 127.50 with SD 5.32). Significant improvement in perceptual analysis was seen post-therapy on GRBAS scale. Improvement in psychosocial aspect was also statistically significant with p-value less than 0.0001 (pre-therapy mean 26.18, SD 1.72 post-therapy mean 7, SD 1.15). Conclusion Voice therapy plays an important role in lowering F0 and alleviation mental agony of the patients with mutational falsetto. How to cite this article Varma A, Agrahari AK, Kumar R, Kumar V. Role of Voice Therapy in Patients with Mutational Falsetto. Int J Phonosurg Laryngol 2015;5(1):25-27

Laryngeal Compensation for Voice Production After CO2 Laser Cordectomy.

ObjectivesCarbon dioxide (CO2) laser cordectomy is considered one of the modalities of choice for treatment of early glottic carcinoma. In addition to its comparable oncological results with radiotherapy and open surgical procedures, it preserves of laryngeal functions including voice production. The aim of this study was to detect how the larynx compensates for voice production after different types of CO2 laser cordectomy for early glottic carcinoma together with assessment of the vocal outcome in each compensation mechanism.MethodsOne hundred twelve patients treated with CO2 laser cordectomy were classified according to their main postoperative phonatory site. Perceptual analysis of voice samples using GRBAS (grade, roughness, breathiness, asthenia, and strain) scale was done for 88 patients after exclusion of the voice samples of all female patients to make the study population homogenous and the samples of 18 male patients due to bad quality (4 patients) or unavailability (14 patients) of their voice samples and the results were compared with those obtained from control group that included 25 age-matched euphonic male subjects.ResultsFive types of laryngeal compensation were defined including: vocal fold to vocal fold, vocal fold to vocal neofold, vocal fold to vestibular fold, vestibular fold, to vestibular fold, and arytenoids hyper adduction. Characters changes of voice produced by each compensation type were found to be statistically significant except for breathiness, asthenia and strain changes in vocal fold to vocal fold compensation type.ConclusionThe larynx can compensate for voice production after CO2 laser cordectomy by five different compensation mechanisms with none of them producing voice quality comparable with that of controls.

Persistent Dysphonia after Laryngomicrosurgery for Benign Vocal Fold Disease

ObjectivesLaryngomicrosurgery (LMS) is used to manage most vocal fold lesions. However, the functional voice outcome of the LMS might be diverse due to the influence of various factors. We intend to evaluate the incidence and etiologic factors of persistent dysphonia after LMS for benign vocal fold disease (BVFD).MethodsWe performed a retrospective review of 755 patients who underwent LMS for BVFD. We analyzed the clinical characteristics, preoperative and postoperative two onths voice studies. Postsurgical dysphonia was defined as grade 1 or above in GRBAS (grade, roughness, breathiness, asthenia, and strain) scale. Thirty nine patients (5.2%; 25 males and 14 females; average, 42.9 years; range, 21 to 70 years) were diagnosed with postsurgical dysphonia.ResultsThere was no correlation between the diagnosis, coexistence with laryngopharyngeal reflux disease, habit of smoking, or occupational voice abuse and voice outcome. The patients with a worse preoperative acoustic parameter had aworse voice outcome. Stroboscopic findings showed excessive scarring or bowing in 21 cases, presence of lesion remnant in eight cases, prolonged laryngeal edema in five and no abnormal findings in three.ConclusionGreat care should be taken in patients with worse preoperative jitter. With a few exceptions, postoperative dysphonia can be avoided by the use of an ppropriate surgical technique.

Cricohyoidoepiglottopexy vs Near-Total Laryngectomy With Epiglottic Reconstruction in the Treatment of Early Glottic Carcinoma

To compare functional and oncological outcomes of cricohyoidoepiglottopexy (CHEP) and near-total laryngectomy with epiglottic reconstruction (NTLER) techniques in early glottic carcinoma. Case series, clinical study. Two tertiary care referral centers. Seventeen patients with T1b glottic squamous cell carcinoma were treated with CHEP and 21 were treated with NTLER. Fundamental frequency, maximum phonation time, maximum phonation intensity, Voice Handicap Index, and GRBAS (grade, roughness, breathiness, asthenia, and strain) scale were used to evaluate voice. Nasogastric tube removal times and late postoperative aspiration scales were used to evaluate swallowing ability. Fundamental frequency (P=.78), maximum phonation time (P=.44), and maximum phonation intensity (P=.94) measurements were not significantly different in the 2 groups. There was also no significant difference in mean Voice Handicap Index score (P=.62), mean decannulation time (P=.25), time to nasogastric tube removal (P=.12), or clinical grades of late postoperative aspiration (P=.87) between the 2 groups. The mean Voice Handicap Index score was 55.58 in the CHEP group and 52.78 in the NTLER group. According to the GBRAS scale, overall voice quality was moderately altered in both groups. All patients were successfully decannulated. In the CHEP and NTLER groups, the mean decannulation times were 27 and 20 days, respectively, and the nasogastric tubes were removed after an average of 23 and 17 days. The overall (Kaplan-Meier) survival rate was 94% in the patients who underwent CHEP and 90% in the patients who underwent NTLER (P=.76). The disease-free survival rates were 100% and 76% in the CHEP and NTLER groups, respectively (P=.07). Functional and oncological results appear to be similar with both treatment methods. If open surgery is planned, the choice between these procedures mainly depends on the experience and preference of the surgeon.