GRBAS Score Research Articles

Voice Outcomes following a Single Office-Based Steroid Injection for Vocal Fold Scar.

Persistent dysphonia from vocal fold scar remains a clinical challenge, with current therapies providing inconsistent outcomes. We evaluated voice outcomes after a single office-based steroid injection. Case series with chart review. Academic medical center. This study was based on pre- and postoperative analysis of patient-reported, perceptual, acoustic, aerodynamic, and videostroboscopic parameters. The sample comprised 25 patients undergoing office-based dexamethasone injection into the superficial lamina propria for mild/moderate vocal fold scar. Average follow-up was 13.7 ± 4.4 weeks; patients completed 3.5 ± 2.3 sessions of voice therapy between assessments. Complete data sets were not available for each parameter; sample size is noted with results. Voice handicap index (n = 24; P < .001) and glottal function index (n = 22; P < .001) decreased after injection. Total GRBAS score (grade, roughness, breathiness, asthenia, strain) decreased (n = 25; P < .001). Fundamental frequency range increased (n = 24; P = .024). Phonation threshold pressure decreased (n = 14; P = .017). Videostroboscopic parameters of vocal fold edge (P = .004), glottic closure (P = .003), and right mucosal wave (P = .016) improved after injection. Office-based steroid injection combined with voice therapy for mild/moderate vocal fold scar is associated with improved patient-reported and functional voice measures. These findings provide preliminary support for this approach. Importantly, the procedure is low risk and can be performed in the office, thus offering a simple treatment alternative to patients with a disorder that has traditionally been difficult to manage. Prospective studies evaluating the effects of multiple injections are warranted.

Injection laryngoplasty using hyaluronic acid for Chinese patients with unilateral vocal fold paralysis

Objectives: Injection laryngoplasty using hyaluronic acid for patients of unilateral vocal fold paralysis (UVFP) is becoming more common in Hong Kong. The present investigation attempted to explore the efficacy of the procedure by studying videostroboscopic information, patients' quality of life (QOL), and vocal characteristics obtained before and after injection laryngoplasty.Method: Visual, perceptual, and acoustic data were collected from 11 UVFP patients during their visits before, 1 week, 1 month, and 3 months after injection laryngoplasty. During each visit, the UVFP patients underwent videostroboscopic examination. They were also instructed to maximally sustain the vowels /i, a, u/ and to read aloud a short passage. Fundamental frequency values, perceptual voice quality ratings, and voice handicap index (VHI-30) scores were obtained. Data obtained before and after the surgery were compared.Results: Videostroboscopic examination showed a significant improvement in glottal closure over time. VHI-30 indicated that the voice-related QOL was improved. GRBAS scores also showed significant improvement in perceived vocal quality. However, no significant difference was found in fundamental frequency before and after the procedure.Conclusion: Injection laryngoplasty is effective in helping UVFP patients achieve better voice quality and improved QOL. The procedure also appears to show immediate and sustainable effect to up to 3 months post-surgery.

Does CPAP treatment affect the voice?

The aim of this study was to investigate alterations in voice parameters among patients using continuous positive airway pressure (CPAP) for the treatment of obstructive sleep apnea syndrome. Patients with an indication for CPAP treatment without any voice problems and with normal laryngeal findings were included and voice parameters were evaluated before and 1 and 6 months after CPAP. Videolaryngostroboscopic findings, a self-rated scale (Voice Handicap Index-10, VHI-10), perceptual voice quality assessment (GRBAS: grade, roughness, breathiness, asthenia, strain), and acoustic parameters were compared. Data from 70 subjects (48 men and 22 women) with a mean age of 44.2 ± 6.0 years were evaluated. When compared with the pre-CPAP treatment period, there was a significant increase in the VHI-10 score after 1 month of treatment and in VHI- 10 and total GRBAS scores, jitter percent (P = 0.01), shimmer percent, noise-to-harmonic ratio, and voice turbulence index after 6 months of treatment. Vague negative effects on voice parameters after the first month of CPAP treatment became more evident after 6 months. We demonstrated nonsevere alterations in the voice quality of patients under CPAP treatment. Given that CPAP is a long-term treatment it is important to keep these alterations in mind.

Voice Outcome Following Carbon Dioxide Laser Assisted Microlaryngeal Surgery.

Very few studies have been conducted in South Indian population to evaluate glottic function and voice outcome following carbon dioxide (CO2) laser assisted microsurgery for benign lesions of the larynx. This is a descriptive study which aims at assessing the voice outcome (perceptual and acoustic) and vocal fold function (stroboscopic) following CO2 laser excision in benign vocal fold lesions. 50 adult patients with benign laryngeal lesions were selected to undergo CO2 laser excision in super-pulse mode at power setting of 6 watts. Perceptual analysis was done using GRBAS score. Voice analysis was done using Praat software and fundamental frequency, jitter, shimmer and harmonics to noise ratio were assessed. Stroboscopy was done to evaluate vocal fold function using glottic closure and mucosal wave pattern as parameters. Evaluation of these parameters was done pre-operatively and at 2, 6weeks and 3months post-operatively. Perceptual analysis revealed a significant improvement in the GRBAS score after surgery (p<0.001). Acoustic analysis showed that all the parameters improved significantly after surgery (p<0.001). Stroboscopy showed that vocal fold function improved in 98% of patients in terms of completeness of glottic closure and regular, periodic mucosal wave. Super-pulse micro-spot carbon dioxide laser is a safe and effective treatment option for benign lesions of vocal folds, with excellent voice outcome.

Effects of Type 3 Thyroplasty on Voice Quality Outcomes in Puberphonia

Objective: To assess effects of type 3 thyroplasty on outcomes of voice quality in puberphonia.&#x0D; Methods:&#x0D; Design: Prospective Cohort&#x0D; Setting: Tertiary Referral Hospital&#x0D; Participants: 6 patients with puberphonia who failed voice therapy, aged 16-25 years, who consulted at the ENT Outpatient department between September 2010 and September 2012, underwent type 3 thyroplasty.&#x0D; Pre-operative and 6-month post-operative voice analysis by voice recordings, Voice Handicap Index (VHI), GRBAS score and real time acoustic analysis (perturbation) using Dr Speech software (University version 4.0, Voice Tech Corporation, USA [Tiger Electronics]) using habitual fundamental frequency (F0), jitter % and shimmer % as parameters, were performed.&#x0D; &#x0D; Results: Mean pre-operative VHI and GRBAS scores were 53 and 75.67 respectively whereas post-operative scores were 29 and 25.00 respectively. (P-value for VHI was 0.004 and that of GRBAS was 0.00). On acoustic analysis, mean pre-operative habitual fundamental frequency (F0), jitter % and shimmer % was 245.82 Hz, 0.21 and 2.34 respectively whereas post-operative mean was 140.78 Hz (P = 0.00), 0.19 (P = 0.04) and 1.52 (P = 0.00) respectively.&#x0D; &#x0D; Conclusion: The mainstay of treatment of puberphonia is voice therapy. Thyroplasty provides a suitable management option in those cases who fail to respond by voice therapy.&#x0D; &#x0D; Keywords: puberphonia, thyroplasty, laryngeal framework surgery, voice analysis

Vocal outcome after endoscopic thyroarytenoid myoneurectomy in patients with adductor spasmodic dysphonia.

Spasmodic dysphonia (SD) remains one of the most difficult of laryngeal pathologies to treat. With limited role for speech therapy, various surgical modalities have been tried with various success rates. The objective of the study is to report the results of vocal outcome after thyroarytenoid myoneurectomy in patients of adductor spasmodic dysphonia (ASD). 15 patients of ASD were selected. GRBAS, and voice handicap index (VHI) were used for perceptual evaluation of voice. Thyroarytenoid myoneurectomy was performed by vaporizing the muscular layer of the vocal fold with CO2 laser, at an intensity of 6 W with 1.2 mm diameter in scanner mode. Voice analysis was repeated at 12, 24 and 48 months follow-up. Preoperative GRBAS scores and VHI score of all the patients were poor. At 12 months 12/15 (80 %) patients having strain score of 0. There was marked improvement in VHI scores at 6 months. 10/15 (67 %) patients have been followed up for 24 months. 5/10 (50 %) patients have strain (S) value of 0. VHI scoring of 5/10 (50 %) patients was <30. Two of the four patients completed 48 months follow-up had a strain (S) value of 0, one patient has strain value of 1 and one patient had strain value of 2. 2/4 patients had VHI score of <30; one patient had that of 40. Trans-oral CO2 laser thyroarytenoid myoneurectomy shows significant long-term improvement in voice quality in terms of reduced speech brakes, effort and strain in voice.

Comparative Assessment on Laryngeal Function after Radiotherapy and Laser Surgery against Early Glottic Cancer

Objectives: Comparatively assess the laryngeal function and quality of life (QOL) of the patients after laser surgery and radiotherapy against early glottic cancer. Methods: Sixty-seven patients with T1 glottic cancer treated in our institution with radiotherapy (RT, n=30) or CO2 laser surgery (LS, n=37) were incorporated in this retrospective cohort study. LSs were performed following the type II subligamental cordectomy concept. Patients in LS group were categorized into subgroups for further analyses. Twenty-seven patients had vaporization of the lesion with defocused mode, and a residual 10 patients had cancer excision with focused mode using relatively lower power (LS-EX group). GRBAS subjective voice assessment scale, maximum phonation time, and acoustic parameters were measured as vocal parameters. Voice-Related Quality of Life Measure and Voice Handicap Index were used to evaluate post-therapeutic QOL. Laryngeal videostroboscopic images were further examined to assess post-therapeutic laryngeal pliability. The mean follow-up period was 46 months. Results: Compared with their pre-therapeutic scores, worse GRBAS scores were observed at the end of the treatments in 20% and 60% of RT group and LS group respectively. Although these scores recovered 1 year after treatment, abnormal stroboscopic findings remained in 40% and 95% of RT group and LS group respectively. Interestingly, further subgroup analysis proved no significant difference of post-therapeutic vocal parameters and QOL between RT group and LS-EX group. Conclusions: Early glottic cancer could be treated with equivalent post-therapeutic laryngeal function and QOL with either radiotherapy or focused low power CO2 laser surgery.

Pre and Post Operative Voice Analysis After Medialization Thyroplasty in Cases of Unilateral Vocal Fold Paralysis

The present study was undertaken to assess the efficacy of medialization thyroplasty on outcome of voice quality in vocal cord paralysis by analyzing the voice. A total 19 patients with vocal cord paralysis of different etiologies were included in the study. Preoperative voice analysis was done by voice recordings, GRBAS score, maximum phonation time (MPT) and acoustic analysis using Dr Speech software (University version 4.0) using habitual fundamental frequency (F0), jitter %, shimmer % and normalized noise energy (NNE) as parameters. 18 patients underwent type 1 or medialization thyroplasty alone and 1 patient had undergone medialization thyroplasty along with arytenoids adduction. Post operative voice analysis was done using same parameters. There was post operative improvement of voice in 16 patients whereas 3 patients showed no significant improvement. Mean preoperative MPT was 4.8947s and post operative was 13s. Mean preoperative GRBAS score was 76.1579 and post operative was 30. On acoustic analysis, mean preoperative habitual fundamental frequency (F0), jitter %, shimmer % and NNE was 278.16Hz, 1.7, 6.81 and 1.81dB respectively whereas post operative mean was 132.37Hz, 0.41, 1.65 and 123.38dB respectively. Thyroplasty offers good voice outcome in patients of uncompensated vocal cord paralysis. Improvement can be documented in terms of perceptual evaluation of voice and acoustic analysis as well as maximum phonation time in addition to voice recording.

Effect of the 532nm pulsed KTP laser in the treatment of Reinke's edema

To evaluate the effect and safety of the 532nm Pulsed Potassium-Titanyl-Phosphate (KTP) laser in the office-based treatment of patients with Reinke's edema using objective and subjective scaled outcome measures. Case Series. Tertiary hospital center. Seven adult females undergoing in-office KTP laser treatment for Reinke's edema. Participants were studied pre- and posttreatment. Vocal function was evaluated by objective aerodynamic and acoustic analysis. Subjective changes were evaluated using the GRBAS scale, Voice Handicap Index, and videostroboscopy. Histologic effects of the laser were investigated by comparing one patient treated with laser one year prior to excision, one treated with laser just prior to excision, and one control patient who underwent excision without prior laser treatment. At an average postoperative follow up of 17.8 weeks (range 5-78), maximum phonation time trended toward improvement. The median VHI score decreased from 37 to 26 (p=0.150). There was a reduction in each component of the GRBAS scoring and the median fundamental frequency increased from 162 to 186 (p=0.625). Stroboscopic findings demonstrated an intact posttreatment mucosal wave. Histologic comparison of the tissue effects of laser in three patients demonstrated changes in vocal fold vascularity but no acute or long-term damage to the overlying epithelium. Objective and subjective scaled measures suggest that treatment of Reinke's edema in the office with a 532nm KTP laser may result in improved voice. It appears safe with histologic preservation of the vocal fold vibratory epithelium and persistence of mucosal wave.

Behcet’s disease impairs voice quality without laryngeal and hypopharyngeal involvement

The objective of the study was to investigate voice evaluation parameters in Behcet's disease patients. A prospective controlled study was performed in a tertiary referral center. A total of 31 patients (21 female, 10 male) with a diagnosis of Behcet's disease had voice evaluations by means of laryngostroboscopy, acoustic analysis, aerodynamic measurements and perceptual assessment. Data obtained from the patients were compared to 31 healthy control subjects. Laryngeal endoscopy was within normal limits in all patients. The mean fundamental frequency in male control subjects (134 ± 14 Hz) was significantly higher than in male patients (124 ± 20 Hz), (p = 0.043). Mean intensity was significantly higher in control subjects (74 ± 5 dB) than in the patients (63 ± 4.6 dB), (p < 0.001). Shimmer in patients (3.4 ± 2.5) was significantly higher than in control subjects (2 ± 1.3), (p = 0.01). Maximum phonation time in control subjects (25 ± 5.8 s) was significantly longer than in patients (20 ± 7.9 s), (p = 0.007), and s/z ratio was found to be nearly equal between patients (0.9 ± 0.2) and control subjects (0.96 ± 0.1), (p > 0.05). The patients showed a mean GRBAS score of 1.8 ± 1.9 and the control group showed a mean score of 0.48 ± 1.06, (p = 0.002). The VHI-10 scale revealed a mean score of 2.2 ± 4.8 in BD patients and 2 ± 2 in control subjects (p > 0.05). Behcet's disease impaired voice quality without laryngostroboscopically visible laryngeal and hypopharyngeal involvement. This impairment was documented by objective voice evaluation methods including acoustic analysis and aerodynamic voice measurements and by subjective voice evaluation method including perceptual assessment.

Multidimensional Evaluation of Vocal Function after Supracricoid Laryngectomy with Cricohyoidopexy

The aim of this study was to assess the vocal outcome and the impact of arytenoid resection on vocal function following supracricoid laryngectomy with cricohyoidopexy. Twenty-eight male patients who had undergone supracricoid laryngectomy with cricohyoidopexy were included in the study. In 7 patients, one arytenoid cartilage had been totally resected; in 11, both arytenoid cartilages had been preserved; and in 10, one arytenoid cartilage had been partially resected. The maximum phonation time, fundamental frequency, jitter, shimmer, and noise-to-harmonics ratio were assessed and analyzed. Perceptual analysis was performed with the grade, roughness, breathiness, asthenia, and strain (GRBAS) scale. Abduction-adduction and anteroposterior squeezing actions were analyzed from videoendoscopic records. The Voice Handicap Index-10 (VHI-10) was used for self-assessment. The acoustic and aerodynamic parameters and GRBAS score showed severe impairment. The self-assessment revealed that patients were relatively satisfied with their voice quality. There were no statistically significant differences in the acoustic and aerodynamic parameters, the GRBAS score, or the VHI-10 score according to the level of arytenoid resection. Supracricoid laryngectomy with cricohyoidopexy caused deterioration of acoustic and aerodynamic voice parameters and the GRBAS score. Statistically, the level of arytenoid resection had no apparent effect on the objective, perceptual, or subjective voice parameters.

Combination of Voice Therapy and Antireflux Therapy Rapidly Recovers Voice‐Related Symptoms in Laryngopharyngeal Reflux Patients

Patients with laryngopharyngeal reflux frequently experience voice-related symptoms. This study was designed to investigate the effectiveness of combined voice and medical therapy in comparison with medical therapy alone in the improvement of voice-related symptoms and parameters in patients with laryngopharyngeal reflux. Concurrent nonrandomized comparative trial. Otolaryngology department at a university hospital. In this prospective study, 100 patients diagnosed with laryngopharyngeal reflux with voice symptoms were divided into 2 groups: 50 patients were treated with medication alone, and 50 were treated with medication plus voice therapy. The following data were recorded before treatment and at 1, 2, and 3 months posttreatment: reflux symptom index (RSI), reflux finding score (RFS), voice handicap index (VHI), perceptual analysis, and acoustic analysis. The numbers of patients showing clinically significant reductions in these parameters were compared between groups using the following cutoff values: change in RSI ≥5, change in RFS ≥3, change in VHI ≥15, and change in grade, roughness, breathiness, asthenia, and strain scale (GRBAS) ≥1. Significantly more patients in the study group showed a clinically significant change in RSI, VHI, and GRBAS score at the 1-, 2-, and 3-month follow-up evaluations. No clinically significant change in RFS was achieved in either group at 1 or 2 months, but a significantly greater change was achieved in the study group at 3 months. Voice therapy may help to restore reversible mucosal change secondary to acidic reflux, inducing rapid resolution of symptoms and shortening of the treatment period.

Perceived vocal morbidity in a problem asthma clinic

Asthma treatment has the potential to affect patients' voices. We undertook detailed characterisation of voice morbidity in patients attending a problem asthma clinic, and we determined how patients' perceptions related to objective assessment by an experienced observer. Forty-three patients took part in the study. Subjects completed the self-administered voice symptom score (VoiSS) questionnaire and underwent digital voice recording. These voice recordings were scored using the grade-roughness-breathiness-asthenicity-strain system (GRBAS). Laryngoscopy was also performed. The median VoiSS was 26 (range three to 83). VoiSS were significantly lower in the 17 patients with normal laryngeal structure and function (range four to 46; median 22), compared with the 26 patients with functional or structural laryngeal abnormality (range three to 83; median 33) (95 per cent confidence intervals for difference 0.0-21.0; p = 0.044). The overall grade score for the GRBAS scale did not differ between these two groups, and only 13 patients had a GRBAS score of one or more, recognised as indicating a voice problem. There were positive correlations between related GRBAS score and voice symptom score subscales. Although voice symptom scores were significantly more abnormal in patients with structural and functional abnormalities, this score performed only moderately well as a predictive tool (sensitivity 54 per cent; specificity 71 per cent). Nevertheless, the voice symptom score performed as well as the more labour-intensive GRBAS score (sensitivity 57 per cent; specificity 60 per cent). Patients' inhaled corticosteroid dose (median dose 1000 microg beclomethasone dipropionate or equivalent) had a statistically significant relationship with their overall grade score for the GRBAS scale (r = 0.56; p < 0.001), but not with their VoiSS. Only one patient had evidence of laryngeal candidiasis, and only two had any evidence of abnormality suggesting steroid-induced myopathy. Vocal morbidity is common in patients with asthma, and should not be immediately attributed to steroid-related candidiasis. The VoiSS merits further, prospective validation as a screening tool for ENT and/or speech and language therapy referral in patients with asthma.

Multidimensional Assessment of Voice After Vertical Partial Laryngectomy: A Comparison With Normal and Total Laryngectomy Voice

The aim of this cross-sectional cohort study was to analyze the acoustic, stroboscopic, and perceptual parameters in patients who had undergone vertical partial laryngectomy (VPL) and to compare them with normal subjects (N) and total laryngectomy (TL) patients. This study was carried out in a tertiary referral Cancer Services Centre. We analyzed data from a total of 51 individuals; six VPL patients, 27 TL patients, and 18 N subjects. Acoustic analysis and videostroboscopy were performed using a computerized speech studio. Perceptual analysis was carried out using the GRBAS scoring system. The mean ages in the three groups were 40.9+/-13.5 (N), 54.3+/-9.5 (VPL), and 63.9+/-10.5 years (TL). Acoustic analysis yielded the following results for N, VPL, and TL, respectively: median fundamental frequency (155.2, 224.9, 106.3 Hz), shimmer (0.6, 1.9, 1.3 dB), and jitter (0.3%, 3.3%, 4.2%). The median maximum phonation time was 21.8 (N), 9.4 (VPL), and 10.3 seconds (TL). The median words per minute (WPM) were 168.5 (N), 126 (VPL), and 127 WPM (TL). Acoustic analysis of VPL voice was significantly different from normal voice (Mann-Whitney, P<0.05) and approximated better to TL parameters. The results of TL and VPL groups show poorer values and larger variability for nearly all the quantitative measures as compared to N subjects. Videostroboscopy demonstrated variable level and amount of closure of the vibrating segment in the reconstructed larynx of the VPL group. VPL GRBAS scores were similar to TL scores with good interrater reliability. The multidimensional assessment of voice in VPL patients is significantly worse than in N subjects and more closely resembles that of patients who have undergone TL with surgical voice restoration.

One-year follow-up results of combined use of CO2 laser and cold instrumentation for Reinke’s edema surgery in professional voice users

The purpose of this study was to present our experience with combined use of CO2 laser and cold instrumentation for Reinke's edema surgery and to evaluate 1-year follow-up results of the technique in a series of professional voice users. Fifteen patients with Reinke's edema who underwent microlaryngoscopic surgery were included. Videolaryngostroboscopy, perceptual and acoustic voice analyses were performed before and after surgery. During the 1-year follow-up, no recurrence of Reinke's edema was encountered. Significant postoperative improvement was obtained in the quality of voice, in terms of GRBAS scores, Fo, jitter, shimmer and NHR. No evidence of laryngeal cancer was found on the histological examinations. Combined use of CO2 laser and cold instrumentation provides a reliable and safe method for Reinke's edema surgery, and cessation of smoking, voice rest and control of the laryngopharyngeal reflux contribute to the success of surgery. We consider that the removal of redundant mucosa of the vocal fold reduces the risk of the recurrence of Reinke's edema and provides better quality of voice. However, it does not imply that our method is superior to others', but this procedure constitutes an effective treatment of choice for Reinke's edema patients, including professional voice users.

Objective Voice Analysis in Dysphonic Patients: New Data Including Nonlinear Measurements

Objectives/Hypothesis: This report describes a comparative study of objective voice evaluation using a multiparametric protocol including aerodynamic parameters and linear and nonlinear acoustic parameters recorded on an EVA® workstation and perceptual voice analysis by a jury. Study Design: A total of 449 samples were retrospectively selected including 391 patients with pathological voices (308 women and 141 men) and 58 controls with normal voices (38 women and 20 men). A prospective complementary study concerning 43 female patients and 3 controls is presented. Methods: Objective measures included fundamental frequency (Fo), intensity, jitter, signal-to-noise ratio (SNR), Lyapunov coefficient (Lya), oral airflow (OAF), estimated subglottic pressure (ESGP), maximum phonatory time (MPT) and vocal range. A jury of 4 experienced listeners was instructed to classify voice samples (continuous speech) according to the G (overall dysphonia) component of the GRBAS score on a Visual Analogue Scale (VAS) secondarily transformed in a scale ranging from 0 for normal to 3 for severe dysphonia. Results: It was shown that a nonlinear combination of only 7 parameters in women (vocal range, Lya, ESGP, MPT, OAF, SNR, and Fo) and 6 parameters in men (vocal range, Lya, OAF, ESGP, Fo, SNR) allowed classification of 81% voice samples in the same grade as the jury in women and 84% in men. In the prospective study, 80.5% were correctly classified with the same set of objective measurements. Discussion: The relative importance of the different objective parameters in this type of discriminant analysis is dealt with. Special emphasis is placed on Lya.

声門上部圧迫を伴うｍｕｓｃｌｅ ｔｅｎｓｉｏｎ ｄｙｓｐｈｏｎｉａにおける喉頭所見と音声所見との関連性

Muscle tension dysphonia (MTD) is a voice disorder associated with abnormal laryngeal posture or glottic configuration induced by excessive contraction of the laryngeal muscles, and supraglottic contraction is one of the characteristic findings in MTD. In recent study we investigated the changes in laryngeal findings and voice quality and the association between them in the course of voice therapy for MTD with supraglottic contraction. The effects of voice therapy on the laryngeal and the vocal findings were assessed by two rating methods: the MTD score and the conventional GRBAS scores and both scores were gradually improved. Of the two components of supraglottic contraction, false vocal cord compression was more curable than anterior-posterior compression at the aryepiglottic level. Little correlation was found between the scores at the first examination, but significant associations (p < 0.05) were found between the differences of MTD score and G/R/S scores but not B/A scores before and after the series of voice therapy. These results suggest that supraglottic contraction is a crucial factor worsening voice quality and that MTD score is useful to assess the efficacy of voice therapy for MTD.

Use of loud phonation as a voice therapy technique for children with vocal nodules

For the treatment of vocal nodules, educational programs for vocal hygiene and voice training for acquisition of correct phonation are essential. In the case of children, special considerations are necessary as some of their vocal behaviors and reaction to voice disorders are different from those of adults. In this study, a voice therapy program for child vocal nodules were developed and good results were obtained for six children. They were four boys and two girls (Age: 4–11 yr) and bilateral nodules were found for all of them. In addition to a conventional vocal hygiene program for children, correct production of loud voice (so-called gBeltingh) was the major focus of the voice therapy as the visual inspection of the larynges and perceptual evaluations of the voice revealed inappropriate loud voice production with laryngeal constriction in all children. After 5–24 voice therapy sessions, disappearance of the nodules was found in five children and the reduction of the nodule sizes was found in one child. Improvement of the GRBAS scores, longer maximum phonation time, and extension of vocal ranges were found after the completion of the therapy programs.

Objective Voice Analysis for Dysphonic Patients: A Multiparametric Protocol Including Acoustic and Aerodynamic Measurements

The purpose was to determine the clinical value of a multiparametric objective voice evaluation protocol including acoustic and aerodynamic parameters measured mainly on a sustained /a/. This was done by comparison with perceptual analysis of continuous speech by a jury composed of 6 experienced listeners. Voice samples (continuous speech) from 63 male patients with dysphonia and 21 control subjects with normal voices were recorded and assesed by a jury of listeners. The jury was instructed to classify voice samples according to the G (overall dysphonia) component of the GRBAS score on a 4-point scale ranging from 0 for normal to 3 for severe dysphonia. Objective parameters were recorded on an EVA ® workstation. As usual with this type of system, parameters were measured mainly on a sustained /a/. Measured parameters included fundamental frequency (F 0), intensity, jitter, shimmer, signal-to-noise ratio, Lyapunov coefficient (LC), oral airflow (OAF), maximum phonatory time (MPT), and vocal range (range). Estimated subglottic pressure (ESGP) was determined on a series of /pa/. Discriminant analysis was performed to detect correlation between jury classification and combinations of parameters. Results showed that a nonlinear combination of only six parameters (range, LC, ESGP, MPT, signal-to-noise ratio, and F 0) allowed 86% concordance with jury classification. Discussion deals with the relative importance of the different objective parameters for discriminant analysis. Special emphasis is placed on two measurements rarely made in routine clinical workup, i.e., estimated subglottic pressure and Lyapunov coefficient.

Assessment of two objective voice function indices.

In the care of patients with voice disorders, physicians, speech pathologists, and other health care professionals routinely make diagnoses, recommend treatment, and evaluate outcomes. Although objective and subjective measures exist, unfortunately, there is no widely accepted, valid method for classifying voice disorders and assessing outcome after voice treatment. In the present research, the relationship between two previously created multivariate objective voice function indices, the weighted odds ratio index and the multivariate logistic regression index, and subjective assessment of voice function was evaluated. Twenty-three adult patients presenting to a speech science laboratory for evaluation of voice disorders were studied in this prospective observational study together with 12 normal volunteers as controls. Vocal function was measured on 14 different parameters with a protocol that included a multichannel input for simultaneous assessment of acoustic and physiological parameters. Each patient was recorded reading the standard passage "The North Wind and the Sun," and recordings were then evaluated by the GRBAS scale. Overall, there was a statistically significant relationship between the weighted odds ratio index and multivariate logistic regression index and mean GRBAS scores. This research demonstrates that the voice function values calculated from two different multivariate objective voice function indices are significantly associated with subjective voice assessments. These multivariate objective voice indices may be appropriate for use in clinical trials and outcomes research on treatment effectiveness for voice disorders.