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

Evaluation of Voice in Inflammatory Bowel Diseases

Introduction: Inflammatory bowel diseases, which are among the most common chronic gastrointestinal diseases, can also affect the voice for different reasons. The aim of this study was to investigate acoustic, perceptual, and subjective voice evaluation parameters in inflammatory bowel diseases (IBD). Methods: This prospective case-control study included a total of 80 participants: 28 patients with ulcerative colitis (UC), 22 patients with Crohn’s disease (CD), and 30 healthy controls. Following the endoscopic examination, the fundamental frequency (F0), shimmer (dB), jitter (%), and harmonic/noise ratio (HNR) were measured. GRBAS (grade, roughness, breathiness, asthenia, strain) scale was used for perceptual evaluation, and Voice Handicap Index-10 (VHI-10) Turkish version was used for subjective assessment. Results: The F0 value was within normal limits in both disease groups in male and female participants and in the control group. Jitter and shimmer values were statistically higher in the UC and CD groups than in the control group. HNR did not differ between CD and control; however, it was statistically lower in the UC group when compared to both the control and CD groups. The total GRBAS score did not differ between the UC and CD groups; however, it was greater in IBD patients compared to the control group. However, these differences were within normative parameters. Although total VHI-10 score did not differ between UC and CD groups, both had a higher voice handicap than the control group. Conclusion: IBD might have an effect on the voice and voice quality. This disease group was discovered to have perceptual and subjective voice problems additionally.

Comparative Study of the Effect of Experience on Auditory Processing Abilities in Voice Therapists and Other Speech-Language Pathologist in Auditory Perceptual Judgment of Voice

This study aimed to compare the effect of experience on central auditory processing skills in voice therapists and other Speech-Language Pathologists in the auditory perceptual evaluation of voice. This research is a descriptive-analytical cross-sectional observational study. Our study population includes three groups; first-year speech-language pathology students who have not undergone any training or education in the evaluation of auditory samples (group 1; n=10), Speech-Language Pathologists who do not have any activity in the field of voice disorders (group 2; n=10), and therapists who have at least 2years of experience in auditory-perceptual judgment (group 3; n=10). Initially, the participants underwent a basic audiological evaluation (Pure Tone Audiometry, Speech Recognition Threshold, Speech Discrimination Score, tympanometry, and acoustic reflex) to assess peripheral hearing. In the next step, the auditory processing skills of the participants were evaluated with the Buffalo model (staggered spondaic word (SSW) test, phonemic synthesis test (PST), speech in noise (SPN) test). In the third step, four recorded voice samples of patients with voice disorders and healthy individuals were randomly selected for auditory perceptual judgment. These samples were the same for all participants. All the voices were previously subjected to auditory perceptual analysis by two Speech-Language Pathologist who had at least 6years of experience in the evaluation and treatment of voice disorders; the voices were played for participants to assess auditory perception using the grade, roughness, breathiness, asthenia, strain (GRBAS) scale. All subjects had normal hearing and auditory processing abilities but there were some differences among the groups in processing skills. A difference was found in the SSW-qualifier and SPN-R components between the three groups. The third group had significant differences with the other two groups in the evaluation of auditory perception in the components of R, B, and S (from the GRBAS scale) in voice number one, and the components of G, R, and A in voice number three. In voice number two, there was a correlation between the SSW order effect component and the G component, as well as between the PST component and the A component. In voice number three, there was a correlation between the SPN-L component and the G component, and between the SSW condition, SSW qualifier, and SSW All errors components with the S component. In voice number four, there was a correlation between the SSW-RC, SSW-LC, SSW condition, SSW competing, and SSW order effect components with the A component. Lastly, there was a correlation between the SSW order effect and SSW type A components with the R component in voice number three in group three. The results of the present study indicate that experience has an impact on auditory processing skills and the participants of the third group, who had more experience in the evaluation of voice disorders obtained better scores than the other two groups in the auditory processing skills. Additionally, the level of experience is related to the accuracy of auditory perceptual judgment of voice. The participants of the third group performed better than the other two groups, and the performance of the first and second groups was almost the same.

Prediction of Voice Outcomes After Hemithyroidectomy Using Skin Electrode Intraoperative Neuromonitoring

Background and Objectives This study focused on predicting voice outcomes following hemithyroidectomy using skin electrode intraoperative neuromonitoring (IONM).Subjects and Method The study involved 82 patients who underwent hemithyroidectomy. During the surgery, the researchers recorded skin IONM values for the vagus nerve and recurrent laryngeal nerve. Voice quality evaluations were conducted before the surgery and at various intervals after the surgery (one week, one month, three months, six months, and one year) using the multidimensional voice program (MDVP), voice handicap index (VHI), and the grade, roughness, breathiness, asthenia, strain (GRBAS) scale. The study aimed to correlate perioperative skin IONM values with subjective and objective voice outcomes.Results The VHI scores increased up to three months post-surgery, with statistically significant changes observed at one week post-surgery. The GRBAS scale scores also increased significantly at one month post-surgery. Similar trends were observed in the MDVP data, including a decrease in the maximum pitch between one week and three months post-surgery. Additionally, the study found that lower delta-V values (difference between the preoperative and postoperative signal amplitude of vagus nerve stimulation) were associated with higher F0 values at one week and three months post-surgery, while jitter and noise-to-harmonic ratio were higher in the group with higher delta-V values at three months post-surgery.Conclusion Greater differences between the preoperative and postoperative signal amplitude of vagus nerve stimulation during surgery were linked to worse postoperative voice outcomes. Voice parameters worsened for up to 3 months after hemithyroidectomy but showed signs of recovery afterwards. These findings offer insights into predicting and managing voice outcomes after hemithyroidectomy.

Effects of Speech and Language Therapists’ Personality Traits and Cognitive Emotion Regulation on the Perceptual Evaluation of Dysphonia

As in many healthcare fields, it is essential to establish clinical standards for voice assessments; however, some individual characteristics of clinicians, such as their personalities, may affect assessment reliability. Therefore, this study aims to examine the relationship between the personality traits and cognitive emotion regulation strategies of speech-language therapists (SLTs) and their GRBAS (Grade, Roughness, Breathiness, Asthenia, Strain) scoring. The study group comprised 33 SLTs and 9 women with dysphonia. The Five-Factor Personality Inventory (FFPI) and Cognitive Emotion Regulation Questionnaire (CERQ) were used to assess SLTs' psychological traits. The SLTs evaluated the acoustic recordings of sustained vowel phonation /a/ obtained from individuals with dysphonia, using the GRBAS scale. Cronbach's alpha was used to assess inter-rater reliability, and Spearman's correlation analysis was used to analyze the relationships among the variables. The findings revealed that the FFPI dimensions were weakly and significantly related to Grade (G) and Strain (S). In the maladaptive dimensions, with an increase in the scores of the neuroticism dimension of FPPI and the catastrophizing dimension of CERQ, the SLTs gave significantly higher scores to Grade (G). In addition, with an increase in the score of rumination or focus on thought, the SLTs perceived Strain (S) more negatively. Consistent with these findings, in the adaptive dimensions, the SLTs gave higher scores to Grade (G) as the positive refocusing and positive reappraisal scores decreased. The findings of this study showed that, as some maladaptive aspects of personality and cognitive emotion regulation increased and adaptive aspects decreased, the SLTs' perceptions of Grade (G) and Strain (S) became more negative. Additionally, these results suggested the possibility of advanced confounding variables beyond primary factors, such as training and experience in the perceptual voice assessment of the SLTs, and the importance of standardizing professional practices, such as the observation and supervision of experts.

Investigating the Inter-rater Agreement of Farsi-speaking Raters on the Grade, Roughness, Breathiness, Asthenia, and Strain Auditory Perceptual Scale

Background: Auditory perceptual assessment is one of the important evaluations for voice assessment. Among the available auditory-perceptual assessments, the grade, roughness, breathiness, asthenia, strain (GRBAS) auditory perceptual scale has attracted the attention of many researchers and therapists in Iran and other parts of the world. The GRBAS scale is a perceptual voice assessment scale that subjectively assesses voice quality; however, the audio samples in the original GRBAS scale that are used as training tools for raters are Japanese. There are various segmental and suprasegmental differences between the Japanese and Persian languages since these factors can affect the accuracy of the perceptual evaluation. Objectives: This research aims to investigate the inter-rater agreement among the Persian raters who only had access to the Japanese samples in the main profile. Methods: In this study, 8 speech and language pathologists were selected as raters with more than 5 years of clinical experience in evaluating and treating voice disorders. Several 137 audio samples, containing the prolongation of vowel /a/ and reading the standard text “Grandfather Passage” were provided to the participating raters. The raters were asked to score the audio samples based on the GRBAS auditory perceptual scale. The results were statistically analyzed via the Cohen kappa coefficient. Results: The highest agreement in the R parameter was related to rater number 5 (kappa=0.585) while the lowest value was related to parameter S, related to rater number 1 (kappa=-0.018). Conclusion: According to the results, the clinical experience of raters using the Japanese samples cannot lead to an increase in the agreement and ability of Persian-speaking raters in evaluating Persian samples.

Voice Disorders after Total Thyroidectomy: Prospective Evaluation by Patient Self-Assessment, Indirect Laryngoscopy and Ultrasonography

Abstract Voice alterations after thyroidectomy with mobile vocal folds are common. Ultrasonography has been used to assess the mobility of the vocal folds after thyroidectomy. Fifty-four patients underwent thyroidectomy. Indirect laryngoscopy, ultrasonography, and GRBAS (grade, roughness, breathiness, asthenia, strain) scoring were performed preoperatively, 3 days, 2 and 6 months, postoperatively. On the third postoperative day, the mobility of the vocal folds was preserved in 52 patients and pareses were recorded in 2 patients. All patients after thyroidectomy noted the presence of voice alteration in the absence of the postoperative paresis of the vocal folds. On the third postoperative day, the voice was impaired by all criteria of the GRBAS scale, but mainly due to roughness (85%). Sixth month postoperatively, 62% of the subjects considered the voice to be altered. Asthenia was observed in 39%. On the third postoperative day indirect laryngoscopy revealed the unchanged vocal folds, the edema and the shortening of one of the vocal folds in 56%, 42%, and 1.9%. Six months postoperatively, the vocal folds returned to their original form. Indirect laryngoscopy and ultrasonography had 100% concordance in assessing the mobility of the vocal folds. Patients with edema of the vocal folds had a significantly higher mean GRBAS grade than patients without edema. The mean GRBAS score decreased from 3.36 to 0.90, 3 days and 6 months, postoperatively. Voice alteration after thyroidectomy is always present. Postoperative edema represents a likely main cause of voice alteration and resolves within 6 months. Ultrasonography is recommended as alternative to indirect laryngoscopy in assessing of the vocal folds after thyroidectomy.

Association Between Subjective Voice Assessment and Psychological Distress After Thyroidectomy

This study aimed to determine the association between postoperative subjective voice function and psychological distress in patients without laryngeal nerve injury after thyroidectomy. A prospective cohort study. We investigated the factors associated with subjective voice function in patients who underwent thyroidectomy without laryngeal nerve injury between October 2018 and July 2020. The Voice Handicap Index was used to assess subjective voice function, the GRBAS (grade, roughness, breathiness, asthenia, strain) scale to assess objective voice, and the Hospital Anxiety and Depression Scale to assess psychological distress. Among 39 patients who underwent thyroidectomy, 32 had no postoperative laryngeal nerve injury. Postoperative Voice Handicap Index was significantly associated with Hospital Anxiety and Depression Scale-Anxiety score after surgery (rs=0.448, P=.010). In this study, an association was observed between subjective voice function and anxiety following surgery. The finding suggested that nurses and medical practitioners need to consider postoperative anxiety when evaluating patients' voice function after thyroidectomy.

Development and Validation of the Japanese Version of the Consensus Auditory-Perceptual Evaluation of Voice.

Auditory-perceptual evaluation is essential for the assessment of voice quality. The Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) provides a standardized protocol and assessment form for clinicians to analyze the voice quality and has been adapted into several different languages. The aims of this study were to develop the Japanese version of the CAPE-V and to investigate its reliability and validity. The Japanese CAPE-V consisted of the same three speech contexts (vowels, sentences, and conversation) as developed in the original English version. The sentences were designed according to the concepts of the original version and reviewed by Japanese phoneticians. To validate the usefulness of the Japanese CAPE-V, voices of 173 Japanese-speaking subjects (76 subjects with dysphonia and 97 without voice complaints) were evaluated by five experienced judges, according to the Japanese CAPE-V as well as the GRBAS (Grade, Roughness, Breathiness, Asthenia, Strain) scale. The Japanese CAPE-V provided a high interrater reliability (intraclass correlation coefficients [ICCs] > .85 for all the parameters) as well as a high intrarater reliability (ICCs > .85 for all the parameters). In addition, overall severity, roughness, and breathiness in the Japanese CAPE-V were highly correlated with the corresponding dimensions in the GRBAS scale, having Spearman correlation coefficients greater than .8. This study demonstrated the reliability and validity of the newly developed Japanese CAPE-V as an auditory-perceptual evaluation instrument.

Acoustic and perceptual voice parameters in subclinical and overt primary hypothyroidism

ObjectiveHypothyroidism is a common endocrine disorder affecting various systems of the body. Only a few studies have focused on the effect of primary hypothyroidism on voice with objective parameters, and none of them compared the effect of subclinical and overt hypothyroidism on voice. The aim of the present study is to evaluate and compare the acoustic and perceptual parameters of voice in patients newly diagnosed with subclinical and overt hypothyroidism. MethodsThe study included 26 subclinical hypothyroidism, 26 overt hypothyroidism patients and 30 euthyroid control participants. Perceptual evaluation of voice with GRBAS (grade, roughness, breathiness, asthenia, strain) scale, voice handicap index (VHI)-10, and acoustic voice analysis by using Multi-Dimensional Voice Program were performed for all the participants. ResultsThe voice parameters which showed a statistically significant difference between the groups were frequency parameters (Fo; p= 0.003, Fhi; p=0.010, Flo; p= 0.002) and VHI-10 (p= 0.047). A statistically significant decrease in frequency parameters and a statistically significant increase in VHI-10 were found in overt hypothyroidism group comparing with control group (Fo; p= 0.002, Fhi; p=0.009, Flo; p= 0.001 and VHI-10; p= 0.046). Voice parameters in subclinical hypothyroidism group did not show a statistically significant difference comparing with both control and overt hypothyroidism groups. ConclusionIn the present study, overt hypothyroidism is found to affect frequency parameters and patients’ own subjective assessment of voice. Primary hypothyroidism does not seem to have significant effect on voice parameters until thyroxine levels are affected.

Comparisons of 4-Point GRBAS, 7-Point-GRBAS, and CAPE-V for Auditory Perceptual Evaluation of Dysphonia

Purpose: The GRBAS (grade, roughness, breathiness, asthenia, strain) scale, a 4-point scale, has been most widely used for judging auditory-perceptual severity for dysphonia. However, in current clinical practice, sometimes a more fragmented 0.5 scheme is being used if the original GRBAS scale is ambiguous to assess. Thus, the aim of the present study was to compare the dysphonia severity using the three auditory-perceptual evaluation tools, 4-point, 7-point GRBAS scale, and CAPEV and provide the information regarding differentiation of perceptual severity and acoustic correlations.Methods: Voice samples for sustained vowel and connected speech were obtained from 101 dysphonic patients. Auditory-perceptual assessments of dysphonia severity were performed by two certified experienced speech-language pathologists specializing in voice disorders using the grade of a 4-point and a 7-point GRBAS, OS of CAPE-V and also were compared with cepstral measures [cepstrum peak prominence (CPP), low/high spectral ratio].Results: OS and G of inter-rater reliability of dysphonia using CAPE-V and 4-point GRBAS scales were good (ICC > 0.800) while G of 7-point GRBAS was less strong (ICC > 0.681) than OS of CAPE-V and G of 4-point GRBAS scale. The highest correlation with CPP was the OS of CAPE-V in both vowel and connected speech, while L/H ratio showed low correlation with dysphonia severity. The OS of CAPE-V in vowel and connected speech differed significantly in G of both GRBAS scales. On the 4-point GRBAS scale, CPP showed only the difference between G1-G2, G2-G3 groups in /a/ vowel, whereas in the connected speech, the difference between G0-G1, G1-G2, and G2-G3 groups was relatively differentiated. Meanwhile, on a 7-point GRBAS scale, CPP showed only differences between G1.5-G2 groups in sustained vowel, while CPP showed no differences between G0-G0.5, G0.5-G1, G1-G1.5, G2-G2.5, and G2.5-G3 groups respectively in connected speech.Conclusion: 7-point GRBAS scale showed a higher correlation with CPP measures than the original GRBAS, but reduced the discrimination of dysphonia severity compared to the 4-point GRBAS scale. Consequently, modified 7-point GRBAS scale could be useful as a clinically-perceptual evaluation tool, along with the original GRBAS scale and CAPE-V.

Medialization Laryngoplasty After Endoscopic Laser Cordectomy. Our Experience

Medialization laryngoplasty can be performed to treat glottic incompetence after endoscopic laser cordectomy. The aim of this study is to evaluate vocal outcome after this phonosurgical procedure and to analyze the critical aspects of the Montgomery and Gore-Tex laryngoplasty technique. A retrospective observational study of patients with glottic incompetence after endoscopic laser cordectomy, underwent medialization laryngoplasty with Montgomery or Gore-Tex implant between January 2013 to December 2018 at the Bufalini Hospital of Cesena, Italy. The pre- and postphonosurgery evaluation included videolaryngostroboscopy, perceptual, evaluation of dysphonia with the GRBAS (grade, roughness, breathiness, asthenia, strain) scale, Voice Handicap Index-10, Maximum Phonation Time. The outcome was evaluated 6 months after the phonosurgical treatment. We treated 22 patients, 19 males and 3 females. Eight cases were treated with Montgomery implant and fourteen with Gore-Tex implant. The postphonosurgical videolaryngostroboscopy showed an improvement of the glottic closure in all patients; the scores of the Voice Handicap Index-10 and of the Maximum Phonation Time showed a statistically significant improvement after phonosurgery. The GRBAS scale scores showed a statistically significant improvement of Global Grade, Breathiness, and Asthenia; the parameter Strain remained unaltered both in pre- and postoperative evaluations, because the voice was never pressed due to glottic insufficiency, especially in preoperative observation. The parameter Roughness (R) did not show a significant difference between pre- and postoperative evaluation. Medialization laryngoplasty is an effective phonosurgical procedure to improve voice outcome, after extended endoscopic laser cordectomies, in patients with unacceptable results after voice therapy and injection laryngoplasty. In our experience the Gore-Tex implant allows the surgeon to perform a safer and more "tailored" phonosurgery in cases of cordectomies type IV and V, associated or not with radiotherapy and in revision surgery.

Auditory-perceptual voice and speech evaluation in ATP1A3 positive patients

IntroductionBulbar symptoms are frequent in patients with rapid-onset dystonia-parkinsonism (RDP). RDP is caused by ATP1A3 mutations, with onset typically within 30 days of stressor exposure. Most patients have impairments in speech (dysarthria) and voice (dysphonia). These have not been quantified. We aimed to formally characterize these in RDP subjects as compared to mutation negative family controls. MethodsWe analyzed recordings in 32 RDP subjects (male = 21, female = 11) and 29 mutation negative controls (male = 15, female = 14). Three raters, blinded to mutation status, rated speech and vocal quality. Dysarthria was classified by subtype. Dysphonia was rated via the GRBAS (Grade, Roughness, Breathiness, Asthenia, Strain) scale. We used general neurological exams and the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) to assess dysarthria, dystonia, and speech/swallowing dysfunction. ResultsThe presence of dysarthria was more frequent in RDP subjects compared to controls (72% vs. 17%, p < 0.0001). GRBAS voice ratings were worse in the RDP cohort across nearly all categories. Dysarthria in RDP was associated with concordant cranial nerve 9–11 dysfunction (54%, p = 0.048), speech/swallowing dysfunction (96%, p = 0.0003); and oral dystonia (88%, p = 0.001). ConclusionsQuantitative voice and speech analyses are important in assessing RDP. Subjects frequently experience dysarthria and dysphonia. Dystonia is not the exclusive voice abnormality present in this population. In our analysis, RDP subjects more frequently experienced bulbar symptoms than controls. GRBAS scores are useful in quantifying voice impairment, potentially allowing for better assessments of progression or treatment effects. Future directions include using task-specific diagnostic and perceptual voice evaluation tools to further assess laryngeal dystonia.

Efficacy of Low Mandible Maneuver on Mutational Falsetto

Objectives: Mutational falsetto (MF) is a functional voice disorder involving failure to transition from the high-pitched voice of childhood to the lower-pitched voice of adolescence and adulthood. The low mandible maneuver (LMM) is used by professional singers to relax the larynx and expand the resonance space. It relaxes suprahyoid muscles and pushes the larynx backwards, so it can be used as a therapy for MF. Material and Methods: The data of 20 MF patients treated by the LMM were analyzed in this study. All of the patients were asked to complete the Voice Handicap Index-10 (VHI-10) before the first session, and again 2 weeks after the second visit. The Grade-Roughness-Breathiness-Asthenia-Strain (GRBAS) scale scores and fundamental frequency (F0) were analyzed for each patient. Results: All except 1 patient reported that they completed the exercises without difficulty; the patient who did not perform the exercises cited reasons other than their difficulty. Only 2 patients failed to transition from MF to a lower-pitched voice. The GRBAS scale scores (all parameters) differed significantly between the first and second sessions. The VHI-10 score also changed, i.e., self-perceived voice quality was improved significantly, as was the F0. Conclusions: Our results showed that the LMM is an efficient and rapid technique for treating MF patients and shows high patient compliance.

Bilateral Selective Laryngeal Reinnervation for Bilateral Vocal Fold Paralysis in Children

Bilateral vocal fold paralysis (BVFP) in pediatric patients is a challenging entity with multiple causes. Traditional approaches to managing BVFP include tracheostomy, arytenoidectomy, suture lateralization, cordotomy, and posterior cricoid enlargement. These interventions are used to create a stable airway but risk compromising voice quality. To assess the use of bilateral selective laryngeal reinnervation (SLR) surgery to manage BVFP and restore dynamic function to the larynx in pediatric patients. In this case series performed at 2 tertiary care academic institutions, 8 pediatric patients underwent bilateral SLR to treat BVFP (5 patients with iatrogenic BVFP and 3 with congenital BVFP) from November 2004 to August 2018 with follow-up for at least 1.5 years. Bilateral selective laryngeal reinnervation surgery. Flexible laryngoscopy findings, subjective and objective measures of voice quality, subjective swallowing function, and decannulation in patients who were previously dependent on a tracheostomy tube. Participants included 6 boys and 2 girls with a median age of 9.3 (range, 2.2 to 18.0) years at the time of surgery. All 8 patients were decannulated; 6 patients had preoperative tracheostomies and 2 had perioperative tracheostomies. Voice quality, as measured using the GRBAS (grade, roughness, breathiness, asthenia, strain) scale, improved in 6 of 8 patients after reinnervation, and swallowing was not impaired in any patients. In 2 patients, GRBAS scale scores remained the same before and after surgery. Inspiratory vocal fold abduction was observed on both sides in 5 patients and on 1 side in 2 patients, with no active abduction observed in 1 patient. The follow-up period was more than 5 years in 7 of 8 patients and at least 1.5 years in all patients. Bilateral SLR appears to be a promising treatment option for children with BVFP; it is currently the only option, to our knowledge, with the potential to restore abductor and adductor vocal fold movement. In patients with complete paralysis, this procedure may provide a strategy for airway management and restoration of the dynamic function of the larynx. It could be considered as a first-line technique before endolaryngeal or airway framework procedures, which carry a risk of compromising voice quality.

Classification of Voice Disorders Using a One-Dimensional Convolutional Neural Network

Auditory-perceptual voice analysis is a standard method for quantifying pathological voice quality, but perceptual ratings are based on subjective evaluations and therefore may vary among examiners. Although many acoustic metrics have been studied for potential use in the objective evaluation of pathological voices, the interpretation of acoustic metrics in individual cases is difficult and the technique is not widely used by clinicians. The aim of this study was to establish standardized methods to discriminate grade, roughness, breathiness, asthenia, strain (GRBAS) scale scores of pathological voices directly using one-dimensional convolutional neural network (1D-CNN) models. We constructed an original dataset utilizing 1,377 voice samples of sustained phonation of the vowel /a/. Each voice sample was rated by three experts according to the GRBAS scale and the median values were used as the correct answer label. We designed an end-to-end 1D-CNN model with a raw voice waveform input having a frame width of 9,600 samples. The models were trained with our original dataset for each GRBAS category individually and the model performance was tested by the five-fold cross validation method. The accuracy, F1 score, and quadratic weighted Cohen's kappa for the testing dataset were determined. The metrics for the G scale showed the most balanced model performance, with high accuracy (0.771) and substantial agreement (kappa=0.710). The model for the R scale had relatively high accuracy (0.765) and F1 score (0.743) with moderate agreement (kappa=0.536). The accuracy (0.883) and the F1 score (0.865) for the S scale were the highest among the five categories, whereas the Cohen's kappa was the lowest (0.190). The end-to-end 1D-CNN models can evaluate overall pathological voice quality with a reliability comparable to human evaluations. The efficiency with which the machine learning models can be trained and evaluated is closely related to the dataset quality.

Inverse analysis of vocal sound source using an analytical model of the vocal tract

Diseases occurring near the vocal cords, such as laryngeal cancer, share the initial symptom of hoarseness of voice. The GRBAS (grade, roughness, breathiness, asthenia, strain) scale is used as an acoustic diagnostic method for these diseases, but its objectivity is not well established. Instead, more accurate diagnosis may be possible by capturing the waveform of the volume velocity at the vocal cords. The aim of this study is to enable voice disturbances to be diagnosed by identifying the sound-source waveform from voice measurements. For acoustic analysis of the vocal tract, we modeled the air inside it as concentrated masses connected by linear springs and dampers. We identified the shape of the vocal tract by making the natural frequencies of the analytical model correspond to the measured formant frequencies, and we calculated the sound-source waveform from the measured voice waveform. To assess the validity of the model, we measured actual voices and used the model to identify the vocal tract shapes and corresponding sound-source waveforms. The identified waveforms have an asymmetrical triangular form, which is a feature of actual human sound-source waveforms. Local solutions allow multiple vocal tract shapes to be identified from a single sample. However, mathematical analysis showed that these differ only in the amplitude of the sound-source waveform, which does not affect the waveform shape. Furthermore, we built an experimental device that simulates the human voice mechanism and comprises an acrylic vocal tract and a piston. We confirmed that the identified sound sources are similar to measured sound sources. We therefore conclude that our proposed methods are valid.

Voice disorder in systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is a chronic disease characterized by progressive tissue damage. In recent decades, novel treatments have greatly extended the life span of SLE patients. This creates a high demand for identifying the overarching symptoms associated with SLE and developing therapies that improve their life quality under chronic care. We hypothesized that SLE patients would present dysphonic symptoms. Given that voice disorders can reduce life quality, identifying a potential SLE-related dysphonia could be relevant for the appraisal and management of this disease. We measured objective vocal parameters and perceived vocal quality with the GRBAS (Grade, Roughness, Breathiness, Asthenia, Strain) scale in SLE patients and compared them to matched healthy controls. SLE patients also filled a questionnaire reporting perceived vocal deficits. SLE patients had significantly lower vocal intensity and harmonics to noise ratio, as well as increased jitter and shimmer. All subjective parameters of the GRBAS scale were significantly abnormal in SLE patients. Additionally, the vast majority of SLE patients (29/36) reported at least one perceived vocal deficit, with the most prevalent deficits being vocal fatigue (19/36) and hoarseness (17/36). Self-reported voice deficits were highly correlated with altered GRBAS scores. Additionally, tissue damage scores in different organ systems correlated with dysphonic symptoms, suggesting that some features of SLE-related dysphonia are due to tissue damage. Our results show that a large fraction of SLE patients suffers from perceivable dysphonia and may benefit from voice therapy in order to improve quality of life.

Does Even Low-Grade Dysphonia Warrant Voice Center Referral?

Data regarding the referral of dysphonic patients to specialty voice clinics are limited. The objective of this study is to examine the relationship between low perceptual dysphonia severity and subtle laryngeal findings to discern if this can help guide referral. This is a retrospective chart review. The charts of 94 patients presenting with a primary complaint of hoarseness to a single laryngologist over a 1-year period at a tertiary care, interdisciplinary voice center were analyzed. Patients were stratified by clinician perceptual rating of dysphonia severity using the overall Grade score from the GRBAS (grade, roughness, breathiness, asthenia, strain) scale, and this was compared to their laryngeal findings on stroboscopy. Forty-one patients had a Grade score of 0 or 1, of whom 85% had relatively subtle findings on stroboscopy, including vocal fold paresis, muscle tension dysphonia, and spasmodic dysphonia. Patients with a primary complaint of hoarseness but absent or only mild perceptual dysphonia may have subtle or occult laryngeal findings that may be easily missed. These patients may benefit from early referral to a specialty voice center.

Vocal Function Exercises for Muscle Tension Dysphonia: Auditory-Perceptual Evaluation and Self-Assessment Rating

Muscle tension dysphonia (MTD) is a functional dysphonia, which appears with an excessive tension in the intrinsic and extrinsic laryngeal musculatures. MTD can affect voice quality and quality of life. The purpose of the present study was to assess the effectiveness of vocal function exercises (VFEs) on perceptual and self-assessment ratings in a group of 15 subjects with MTD. The study comprised 15 subjects with MTD (8 men and 7 women, mean age 39.8 years, standard deviation 10.6, age range 24-62 years). All participants were native Persian speakers who underwent a 6-week course of VFEs. The Voice Handicap Index (VHI) (the self-assessment scale) and Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS) scale (perceptual rating of voice quality) were used to compare pre- and post-VFEs. GRBAS data of patients before and after VFEs were compared using Wilcoxon signed-rank test, and VHI data of patients pre- and post-VFEs were compared using Student paired t test. These perceptual parameters showed a statistically significant improvement in subjects with MTD after voice therapy (significant at P < 0.05 (*) and P < 0.004 (**)). Also results indicated statistically noticeable reduction in the mean VHI scores across subjects with MTD (significant at P < 0.05 (*) and P < 0.004 (**)). Significant improvement after therapy for participants has been observed by the aid of auditory-perceptual ratings of voice quality (with the GRBAS scale) and the patient's self-assessment ratings measurements (with the VHI). As a result, the data provide evidence regarding the efficacy of VFEs in the treatment of patients with MTD.

The Influence of Native Language on Auditory-Perceptual Evaluation of Vocal Samples Completed by Brazilian and Canadian SLPs

This study aimed to determine the influence of native language on the auditory-perceptual assessment of voice, as completed by Brazilian and Anglo-Canadian listeners using Brazilian vocal samples and the grade, roughness, breathiness, asthenia, strain (GRBAS) scale. This is an analytical, observational, comparative, and transversal study conducted at the Speech Language Pathology Department of the Federal University of Minas Gerais in Brazil, and at the Communication Sciences and Disorders Department of the University of Alberta in Canada. The GRBAS scale, connected speech, and a sustained vowel were used in this study. The vocal samples were drawn randomly from a database of recorded speech of Brazilian adults, some with healthy voices and some with voice disorders. The database is housed at the Federal University of Minas Gerais. Forty-six samples of connected speech (recitation of days of the week), produced by 35 women and 11 men, and 46 samples of the sustained vowel /a/, produced by 37 women and 9 men, were used in this study. The listeners were divided into two groups of three speech therapists, according to nationality: Brazilian or Anglo-Canadian. The groups were matched according to the years of professional experience of participants. The weighted kappa was used to calculate the intra- and inter-rater agreements, with 95% confidence intervals, respectively. An analysis of the intra-rater agreement showed that Brazilians and Canadians had similar results in auditory-perceptual evaluation of sustained vowel and connected speech. The results of the inter-rater agreement of connected speech and sustained vowel indicated that Brazilians and Canadians had, respectively, moderate agreement on the overall severity (0.57 and 0.50), breathiness (0.45 and 0.45), and asthenia (0.50 and 0.46); poor correlation on roughness (0.19 and 0.007); and weak correlation on strain to connected speech (0.22), and moderate correlation to sustained vowel (0.50). In general, auditory-perceptual evaluation is not influenced by the native language on most dimensions of the perceptual parameters of the GRBAS scale.