Grade, Roughness, Breathiness, Asthenia, Strain Research Articles

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.

Acupuncture Combined with Voice Training Improved Voice Function in Patients with Primary Muscular Tension Dysphonia (MTD): A Randomized, Three-Armed, Open-Label Clinical Trial

Objective. This randomized controlled trial aimed to evaluate the clinical efficacy of acupuncture combined with voice training for treating patients with primary muscular tension dysphonia (MTD) (Qi stagnation and blood stasis type in traditional Chinese medicine). Methods. A total of 108 patients with primary MTD (Qi stagnation and blood stasis type) were recruited in this study. The participants were randomly divided into 3 equal groups: a test group and two control groups (control groups 1 and 2). An additional 38 participants without primary MTD were recruited as the healthy group. Control group 1 received acupuncture sessions 3 times per week on alternate days on the Hegu (LI 4), Taichong (LR 3), Open Voice No. 1 point, and Open Voice No. 2 points. Control group 2 received a 40-minute voice training session once weekly. The test group received both treatments. The total treatment course for all groups was 30 days. The healthy participants did not receive any interventions. The physiological and functional voice improvements after treatment were compared between all 3 MTD groups and healthy participants. The Voice Handicap Index (VHI-10), the VHI-10 emotional score, the Chinese Medicine Symptom Score Scale (TCM), and the Grade Roughness Breathiness Asthenia Strain (GRBAS) were used to evaluate the changes in the voice after treatment. A laryngeal muscle blood oxygen monitoring was used to measure the blood oxygen saturation (SO2) of the suprahyoid and infrahyoid muscles, and a stroboscopic laryngoscopy was used to measure the dysphonia severity index (DSI). Acoustic voice analysis was used to measure the maximum phonation time (MPT), the jitter, and the shimmer. Result. The SO2 levels of the laryngeal muscle were significantly higher in the healthy subjects than in pretreatment MTD patients and were correlated with the VHI-10 and DSI scores. A significant improvement in the physiological and functional scores, the total VHI-10, the GRBAS score, the voice acoustic analysis indices, MPT, jitter, shimmer, and DSI, was noted after treatment in all 3 MTD groups ( P < 0.05 ). However, the posttreatment scores in the test group were significantly higher compared to control group 2, whose score were superior than that in control group 1 ( P < 0.05 ). Both the test group and control group 1 showed a significant increase in the SO2 levels of the laryngeal muscles after treatment, where the test group had a higher elevation than control group 1. No significant difference was noted in the posttreatment SO2 of the laryngeal muscles in control group 2 ( P > 0.05 ). Conclusion. Acupuncture monotherapy or in combination with voice training can reduce the anxiety emotion, relieve MTD-associated systemic symptoms, and increase the SO2 levels of the laryngeal muscle. This combination is a promising approach for the treatment of MTD. This trial is registered with ChiCTR2200061469.

Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA): Influences on the Voice Changes and Swallowing Function Disorders.

The aim of this study was to evaluate the influence of transoral endoscopic thyroidectomy vestibular approach (TOETVA) on voice changes and swallowing function disorders. We retrospectively reviewed 215 patients who underwent thyroid surgery with TOETVA (105 cases, endoscopic group) and open approach (110 cases, open group). Major outcomes, the changes in voice and swallowing function in the 2 groups of patients before and after surgery were analyzed by using both subjective and objective evaluation indexes. Subjective evaluation indexes included the Voice Handicap Index, voice GRBAS (Grade, Roughness, Breathiness, Asthenia, Strain) classification, and swallowing impairment score; the objective indicators included the fundamental frequency (F0), fundamental frequency perturbation (jitter), amplitude perturbation (shimmer), and maximum phonation time. In terms of subjective evaluation indexes, there were no significant differences (all P> 0.05) between the groups regarding Voice Handicap Index (1 and 3mo after surgery) and GRBAS (1 and 3mo after surgery). The incidence rates of swallowing disorder in the endoscopic group were higher than that in the open group according to the outcomes of swallowing impairment score at 1 and 3 months after surgery (both P< 0.05). In addition, no significant changes in terms of jitter, shimmer, and maximum phonation time in both groups of patients at 1 and 3 months after surgery compared with their preoperative values (all P> 0.05). Voice and swallowing disorders may occur in some patients, either TOETVA or open thyroid surgery, which in most cases will recover within 3 months after surgery. The time to swallowing function recovery is relatively prolonged in patients following TOETVA, which may be probably associated with neck adhesion and fixation after the operation.

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.

Comparison of Voice Therapy Outcomes: Clinic vs Telehealth

Voice therapy provides patients with valuable exercises and techniques to optimize vocal behaviors and improve their ability to communicate effectively and efficiently. These sessions were typically held by speech-language pathologists (SLPs) in clinic. During the COVID-19 pandemic, SLPs were provisionally able to provide billable voice therapy services in telehealth format. There is a lack of existing research studies comparing outcomes based on the format of voice therapy. A retrospective chart review was performed on 101 patients who underwent voice therapy at a large academic institution in order to compare outcomes between clinic, telehealth, and mixed voice therapy formats. Demographics, dysphonia etiology, duration of symptoms, number of therapy sessions, and pre- and postvoice therapy scores using reflux symptom index (RSI), voice handicap index (VHI-10), consensus auditory-perceptual evaluation of voice (CAPE-V), and Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS) scoring were collected. Statistical comparisons were performed using Fisher's exact test and analysis of covariance. There were no statistically significant differences in pre- to postvoice therapy RSI, VHI-10, CAPE-V, or GRBAS scores based on format of voice therapy, after adjustment for number of therapy sessions received. There were no differences in these outcomes when comparing voice therapy by etiology of dysphonia. Overall, these data support the effectiveness of the telehealth voice therapy format. It is a promising platform for greater patient access to therapy. All formats of voice therapy were effective in improving key measures of voice perception.

Do patients regret having in-office vocal fold injections for glottic insufficiency?

BackgroundIn-office vocal fold injections (VFI) are an effective treatment for glottic insufficiency. The primary objective of this study was to assess if patients reported decisional regret after VFI. Secondary objectives included determining if variables were associated with lower decisional regret.MethodsCase–control study of patients who underwent in-office VFIs for glottic insufficiency from August 2017 to December 2019 at a tertiary laryngology clinic. Participants completed the validated Decision Regret Scale (DRS). Demographic data, clinician’s perceptual analysis with GRBAS (Grade, Roughness, Breathiness, Asthenia, Strain), and patient’s self-reported Voice Handicap Index-10 (VHI-10) were analyzed. Nonparametric tests as well as univariate and multiple logistics regression were performed.ResultsOf patients eligible, 75% (136/182) completed the DRS (mean age 65.4 years (SD 13.9), 58.1% male). Eighty-three (61.0%) reported no decisional regret, thirty-three (24.3%) reported mild decisional regret, and twenty (14.7%) reported moderate to strong decisional regret. Improvement in most recent VHI-10 (Kendall correlation coefficient tau = 0.156, p = 0.029), Grade of voice (tau = 0.236, p value = 0.002) and Breathiness of voice (tau = 0.150, p = 0.044) were associated with lower DRS. Multivariate logistics regression results showed that the change in Grade of voice (OR 9.9, p < 0.01), Roughness (OR 0.2, p < 0.01) and Breathiness (OR 0.2, p < 0.03) were significantly associated with DRS.ConclusionThe majority of patients had no or mild decisional regret after in-office VFI for glottic insufficiency. Both patients who reported less vocal handicap after VFI and clinician-noted improvements in perceptual evaluation of voice after VFI were associated with significantly lower decisional regret.Graphical

Automatic GRBAS Scoring of Pathological Voices using Deep Learning and a Small Set of Labeled Voice Data

Auditory-perceptual evaluation frameworks, such as the grade-roughness-breathiness-asthenia-strain (GRBAS) scale, are the gold standard for the quantitative evaluation of pathological voice quality. However, the evaluation is subjective; thus, the ratings lack reproducibility due to inter- and intra-rater variation. Prior researchers have proposed deep-learning-based automatic GRBAS score estimation to address this problem. However, these methods require large amounts of labeled voice data. Therefore, this study investigates the potential of automatic GRBAS estimation using deep learning with smaller amounts of data. A dataset consisting of 300 pathological sustained /a/ vowel samples was created and rated by eight experts (200 for training, 50 for validation, and 50 for testing). A neural network model that predicts the probability distribution of GRBAS scores from an onset-to-offset waveform was proposed. Random speed perturbation, random crop, and frequency masking were investigated as data augmentation techniques, and power, instantaneous frequency, and group delay were investigated as time-frequency representations. Five-fold cross-validation was conducted, and the automatic scoring performance was evaluated using the quadratic weighted Cohen's kappa. The results showed that the kappa values of the automatic scoring performance were comparable to those of the inter-rater reliability of experts for all GRBAS items and the intra-rater reliability of experts for items G, B, A, and S. Random speed perturbation was the most effective data augmentation technique overall. When data augmentation was applied, power was the most effective for items G, R, A, and S; for Item B, combining group delay and power yielded additional performance gains. The automatic GRBAS scoring achieved by the proposed model using scant labeled data was comparable to that of experts. This suggests that the challenges resulting from insufficient data can be alleviated. The findings of this study can also contribute to performance improvements in other tasks such as automatic voice disorder detection.

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.

Long-term results and safety of fibroblast growth factor injection for unilateral vocal fold paralysis.

ObjectivesTreatments for unilateral vocal fold paralysis (UVFP) include conservative voice rehabilitation, vocal fold injection, and laryngeal framework surgery. We proposed basic fibroblast growth factor (bFGF) injection as a potential novel treatment for UVFP and have reported the short‐term results. In this study, we present the long‐term results and safety of vocal fold bFGF injection as a treatment for UVFP.MethodsThis retrospective study included 42 patients (25 males and 17 females) with UVFP who were administered a local injection of bFGF. The injection regimen involved injecting FGF (0.5 μg/ml in 0.5 ml per side) into the bilateral vocal folds using a 23‐gauge injection needle. Phonological outcomes were evaluated 6 months and 12 months after the injection.ResultsOverall, 26 patients received a single injection of bFGF, six patients received an additional injection, and 10 patients received the additional framework surgery. Maximum phonation time, mean flow rate, pitch range, jitter and shimmer percentages, the total GRBAS (grade, roughness, breathiness, asthenia, strain) score, and voice handicap index scores improved significantly in the long term. In patients who received the additional injection or framework surgery, the effects of bFGF injection were temporary, but did not interfere with the performance of the framework surgery.ConclusionIn total, 42 patients who underwent vocal fold bFGF injections were reviewed. The bFGF injections were effective and safe in the long‐term results for UVFP in the selected cases. Some patients with severe symptoms benefited from the additional framework surgery but not the additional bFGF injection.

A Cross-Sectional Study of Acoustic and Perceptual Changes in Voice During Pregnancy

Introduction: Voice is one of the many systems which may show deviancies during pregnancy. The present study aimed to profile the acoustic and perceptual characteristics of voice during pregnancy. Methods: Pregnant women in the age range of 18-30 years were divided into seven groups starting from the third month of pregnancy to the ninth month of pregnancy, with 30 participants in each group. Praat software was used to collect the phonation and narration sample from each participant at their most comfortable pitch and loudness. The acoustic and perceptual analyses were performed on recorded voice samples. Results: Results revealed that fundamental frequency (F0) is affected by the 6th month of pregnancy until the 9th month of pregnancy. However, jitter and shimmer abnormalities are evident from the 3rd month of pregnancy. The results of the perceptual analysis indicated the presence of roughness and breathiness from the third month of pregnancy until the 9th month of pregnancy. Discussion: The results indicated that fundamental frequency (F0) was affected by the 6th month of pregnancy and continued until the 9th month of pregnancy. The jitter and shimmer abnormalities were evident from the 3rd month of pregnancy. These findings were further supported by perceptual deviations on the Grade Roughness Breathiness Asthenia Strain (GRBAS) scale. Conclusions: These findings are of value for a pregnant woman who is sensitive to the vocal deviations and also for a professional voice user as they are more prone to voice changes or disorders due to their extensive voice usage.

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.

Changes in voice quality, swallowing, and pulmonary function after parathyroidectomy for secondary hyperparathyroidism

ObjectiveTo find changes in voice quality, airway invasion during swallowing, pharyngeal residue after swallowing, acoustic and aerodynamic measurements and pulmonary function tests after total parathyroidectomy plus auto-transplantation for secondary hyperparathyroidism. MethodsWe recruited 38 patients who underwent successful surgery for secondary hyperparathyroidism in this study. Voice quality was evaluated using voice handicap index (VHI-10), eating assessment tool (EAT-10), voice impairment, and the grade, roughness, breathiness, asthenia, strain (GRBAS) scale. Acoustic and aerodynamic measurements included fundamental frequency (F0), maximal phonation time, high pitch, jitter, s/z, shimmer and noise-to-harmonic ratio. Vocal cord mobility, vocal cord closure, premature spillage, the penetration–aspiration scale and the Yale pharyngeal residue severity rating scale (PRSRS) after swallowing were examined using fiber-optic endoscopy. Pulmonary function tests included forced vital capacity, forced expiratory volume in 1 s, bronchodilator test, total lung capacity, diffusion capacity of the lung for carbon monoxide, alveolar volume, and distance and O2 desaturation of the 6 min walking test (6MWT). ResultsFour months after successful parathyroidectomy, VHI-10 improved significantly (p < 0.01); incomplete vocal cord closure decreased significantly (p < 0.01); the Yale PRSRS for vallecula and pyriform sinus improved significantly (p = 0.02 and p = 0.02); F0 and high pitch increased significantly (p < 0.01 and p = 0.01); O2 desaturation (<4%) of 6MWT improved significantly (p = 0.04). ConclusionsParathyroidectomy for secondary hyperparathyroidism can improve the voice quality, vocal cord closure, the Yale PRSRS for vallecular and pyriform sinus and O2 desaturation of 6MWT, and increase F0 and high pitch.

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.

Voice Quality Measurement as an Indicator of Efficiency of Treatment in Laryngopharyngeal Reflux Disease

Introduction Laryngopharyngeal reflux disease can alter the structural and functional integrity of the vocal fold. Objectives of the study was to determine the effect of Laryngopharyngeal Reflux Disease (LPRD) on selected Acoustic, Aerodynamic and perceptual parameters of voice and to establish its effectiveness in therapeutic outcome. Materials and Methods The number of patients enrolled for this prospective observational study was 65, all with Reflux symptom index (RSI) more than 13. Quality of life was evaluated using voice handicap index (VHI). Perceptual evaluation of voice done by Grade Roughness Breathiness Asthenia Strain score (GRBAS) followed by acoustic and aerodynamic analysis. Patients were started on a once daily proton pump inhibitor therapy for 3 months along with vocal hygiene measures and RSI, VHI and voice analysis repeated after the treatment. Results There was significant improvement in the RSI score after treatment. Percent jitter and shimmer showed significant improvement in males post treatment (p value:&lt;0.05). Harmonic to noise ratio improved 3 months post treatment in both sexes. Improvement noted in Maximum phonation time and GRBAS score except asthenia and strain post treatment. Conclusion Measurement of voice quality can be used as an effective tool to monitor the efficiency of treatment of LPRD.

Efficacy of Kinesio taping on Mutational Falsetto: A Double Blind, Randomized, Sham-controlled Trial

ObjectivesThis study aimed to assess the efficacy of Kinesio taping on male patients with mutational falsetto undergoing voice therapy. DesignDouble blind, randomized, sham-controlled clinical trial. ParticipantsInterviews were conducted with thirty seven mutational falsetto patients. Included 32 participants were randomized and divided into two groups. Two were dropped out due to irregular attendance, 30 participants were included in final analysis. InterventionsThe study group was treated with voice therapy and applications of three different therapeutic Kinesio taping techniques with seven Kinesio tapes four times over two weeks, and the control group was treated with voice therapy, and applied to sham Kinesio taping. Outcome measuresThe values of fundamental frequency, jitter, shimmer, noise-harmonic ratio, maximum phonation time, Voice Handicap Index-10 scores, and Grade–Roughness–Breathiness–Asthenia–Strain Scale scores were recorded at the baseline and after the two weeks. ResultsThere were significant differences between the study group and the control group with respect to the values of fundamental frequency (P = 0.011), jitter (P = 0.041), shimmer (P = 0.036), noise-harmonic ratio (P = 0.003), maximum phonation time (P ≤ 0.001), Voice Handicap Index-10 scores (P = 0.036), and Grade–Roughness–Breathiness–Asthenia–Strain Scale scores (P = 0.007; P ≤ 0.021; P = 0.022; P = 0.002; P = 0.021, respectively) at the end of the study. ConclusionsThe study demonstrated that Kinesio taping with voice therapy is an efficient and effective technique for treating mutational falsetto patients.

Comparison between Conventional Microdissection and CO2 Laser in the Treatment of Vocal Cord Polyp

Background: Vocal cord polyp usually arises from the epithelium and the lamina propria. Minimally invasive dissection procedures are employed to treat these vocal cord polyp for an effective outcome. Two types of microsurgical techniques were developed gradually and practiced namely, the conventional laryngeal microsurgery, which involves the use of cold instruments and the laryngeal laser micro-surgery.&#x0D; Objective: To compare the conventional cold dissection and CO2 laser methods in treatment of vocal cord polyp.&#x0D; Methods: A randomized prospective study was conducted at the Department of Otolayngology- Head &amp; Neck Surgery, at Bangabondhu Sheikh Muzib Medical University (BSMMU) between July 2017 and June 2019. A total of 60 cases were studied on the following parameters: a. Visual analysis on stroboscopy b. Voice analysis –GRBAS (grade, roughness, breathiness, asthenia, strain) indices c. Duration of surgery d. Peroperative bleeding.&#x0D; Results: During first postoperative assessment, both groups had the normal symmetrical waves, while 50% of cases still had aperiodicity but all patients had the near normal periodicity in the second postoperative assessment. Regarding glottic closure, during preoperative assessment, almost all patients had incomplete glottic closure due to mass lesion as polyps. During first postoperative assessment, glottic closure was found to be better in group B (83% of cases) than group A (76% of cases), while during second postoperative assessment, all patients of both groups had around 95% glottic closure. The mean duration oflaser technique (7.1 ± 1.1 minutes) was less than the conventional technique time (15.6 ± 1.9 minutes), also mean of operative bleeding of laser technique (zero pack) is less than the conventional two(2 packs).&#x0D; Conclusion: There is no significant difference between both groups in all parameters except operative time and bleeding, as laser technique has less time and clear field.&#x0D; Bangladesh J Otorhinolaryngol; April 2021; 27(1): 17-24

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 &gt; 0.800) while G of 7-point GRBAS was less strong (ICC &gt; 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.