Nondysphonic Group Research Articles

Validation of the Spanish Version of the Voice-Related Quality of Life Questionnaire: Psychometric Properties and Clinical Applications

Introduction: The present study aimed to validate the Voice-Related Quality of Life (V-RQOL), vocal self-assessment questionnaire for Spanish. Methods: The validation and psychometric properties were developed according to the criteria of the Scientific Advisory Committee of Medical Outcomes Trust (SAC). The Spanish translation for linguistic and cultural adaptation of the V-RQOL was used. The study involved 193 participants, including 90 vocally healthy individuals and 103 patients with voice disorders, to establish validity. To evaluate reliability, the protocol was applied to 40 participants with dysphonia, who answered it twice before the treatment. Then to determine response changes, the responses of 13 dysphonic participants to the V-RQOL for Spanish were analyzed after intervention and then compared to the initial ones. Clinicians contrasted subjects’ V-RQOL results with a perceptual analysis of voice quality using the GRBAS scale. In order to determine sensitivity and specificity cut-off values, tools results were subjected to the receiver operating characteristic curve analysis. The sensitivity was obtained from the experimental group (dysphonic group) and the specificity from the control group (non-dysphonic group). Results: This version of the V-RQOL questionnaire may be used as part of the standard assessment process of people with voice complaints and as an outcome of treatment efficacy in clinical trials. Conclusion: A validation of the V-RQOL for Spanish in Chilean population was achieved.

음성장애 성인 여성과 정상음성 성인 여성 간 진성구와 가성구의 음성범위프로파일 비교*

This study compared voice range profiles (VRPs) of modal and falsetto register in 53 dysphonic and 53 non-dysphonic adult women with gliding vowel /a/’. The results shows that maximum fundamental frequency (F0_MAX), maximum intensity (I_MAX), F0 range (F0_RANGE), and intensity range (I_RANGE) are lower in the dysphonic group than in the non-dysphonic group. F0_MAX and F0_RANGE are significantly higher in falsetto register than modal register in both groups. I_MAX and I_RANGE are significantly higher in falsetto register in the non-dysphonic group, but those are not different between two registers in the dysphonic group. There was no statistically significant difference in minimum F0 (F0_MIN) and minimum intensity (I_MIN) between the two groups. Modal-falsetto register transition occurred at 378.86 Hz (F4#) in the dysphonic group and 557.79 Hz (C5#) in the non-dysphonic group, which was significantly lower in the dysphonic group. It can be seen that both modal and falsetto registers in dysphonic adult women are reduced compared to non-dysphoinc adult women, indicating that the vocal folds of dysphonic adult women are not easy to vibrate in high pitches. The results of this study would be the basic data for understanding the acoustic features of voice disorders.

The Cutoff Point and Diagnostic Accuracy of the Voice Handicap Index in Cantonese-Speaking Population

Voice Handicap Index (VHI) has been used extensively in research and clinical settings. It has been suggested to be used as a diagnostic tool in the literature. However, little is known if it could be applied as a diagnostic tool to the Cantonese-speaking population. The study aims to establish cutoff points and the diagnostic accuracy for VHI-30 and VHI-10 to discriminate between Cantonese-speaking dysphonic and nondysphonic individuals. Data from 256 adults from Hong Kong were extracted from a database at a local institution. There were a total of 91 nondysphonic individuals and 165 dysphonic individuals. Receiver operating characteristics curve analysis was conducted to establish cutoff points for VHI-30 and VHI-10. Diagnostic accuracy statistics such as sensitivity, specificity, positive, and negative predicted values (PPV and NPV) and likelihood ratios (LRs) were also reported. The dysphonic group scored higher than the nondysphonic group on the mean scores of both versions of VHI. Receiver operating characteristics curve analysis revealed a moderate to strong area under curve of 0.89 in both VHI-30 and VHI-10. A cutoff point of 18.5 point was yielded for VHI-30 (Sensitivity=86.1%, Specificity=81.3%, PPV=89.3%, NPV=76.3%, LR+=4.60, LR-=0.17) and a cutoff point of 7.5 point was yielded for VHI-10 (Sensitivity=80.6%, Specificity=87.9%, PPV=92.4%, NPV=71.4%, LR+=6.66, LR-=0.22). Both the Chinese VHI-30 and VHI-10 for Cantonese speakers showed promising diagnostic accuracy. VHI can be used as adjunct to clinical diagnosis and treatment outcome measures for voice disorders in the Cantonese-speaking population.

Features of Mild-to-Moderate COVID-19 Patients With Dysphonia

IntroductionTo explore the prevalence of dysphonia in European patients with mild-to-moderate COVID-19 and the clinical features of dysphonic patients.MethodsThe clinical and epidemiological data of 702 patients with mild-to-moderate COVID-19 were collected from 19 European Hospitals. The following data were extracted: age, sex, ethnicity, tobacco consumption, comorbidities, general, and otolaryngological symptoms. Dysphonia and otolaryngological symptoms were self-assessed through a 4-point scale. The prevalence of dysphonia, as part of the COVID-19 symptoms, was assessed. The outcomes were compared between dysphonic and nondysphonic patients. The association between dysphonia severity and outcomes was studied through Bayesian analysis.ResultsA total of 188 patients were dysphonic, accounting for 26.8% of cases. Females developed more frequently dysphonia than males (P = 0.022). The proportion of smokers was significantly higher in the dysphonic group (P = 0.042). The prevalence of the following symptoms was higher in dysphonic patients compared with nondysphonic patients: cough, chest pain, sticky sputum, arthralgia, diarrhea, headache, fatigue, nausea, and vomiting. The severity of dyspnea, dysphagia, ear pain, face pain, throat pain, and nasal obstruction was higher in dysphonic group compared with nondysphonic group. There were significant associations between the severity of dysphonia, dysphagia, and cough.ConclusionDysphonia may be encountered in a quarter of patients with mild-to-moderate COVID-19 and should be considered as a symptom list of the infection. Dysphonic COVID-19 patients are more symptomatic than nondysphonic individuals. Future studies are needed to investigate the relevance of dysphonia in the COVID-19 clinical presentation.

Mandarin (Simplified) Chinese Version of the Voice Activity and Participation Profile: Adaptation and Validation

The purpose of this study was to evaluate the reliability and validity of the Mandarin (simplified) Chinese version of Voice Activity and Participation Profile (MC-VAPP) in mainland China. This study enrolled 786 subjects from February 2015 to March 2017, including 456 individuals with voice disorders (dysphonic group) and 330 vocally healthy individuals (nondysphonic group). The internal consistency (Cronbach alpha coefficient), test-retest reliability (intraclass correlation coefficient [ICC]), and differences in the MC-VAPP scores were compared between the two groups. Exploratory factor analysis was performed. The receiver operating characteristic curve and cutoff point were calculated. The MC-VAPP had a high internal consistency. Cronbach alpha coefficients for the subsection scores were from 0.86 and 0.96, with 0.98 for the total score. Test-retest reliability was high for the total score (ICC = 0.98). The four factors' cumulative contribution was determined to be 74.68%. The dysphonic participants displayed significantly higher total score and subsection scores than the nondysphonic participants (P < 0.001). There were significant differences in total activity limitation scores and the total participation restriction scores between the two groups (P < 0.001). The cutoff point for screening between the two groups was 36.5, with a sensitivity of 76.80% and specificity of 80.30%. The MC-VAPP is a reliable and valid instrument for the evaluation of voice-related quality of life in Chinese-speaking individuals. It is also recommended that the MC-VAPP would be a useful tool for screening individuals with and without voice disorders based on the cutoff value of 36.5.

Dysphonia risk screening protocol

OBJECTIVE:To propose and test the applicability of a dysphonia risk screening protocol with score calculation in individuals with and without dysphonia.METHOD:This descriptive cross-sectional study included 365 individuals (41 children, 142 adult women, 91 adult men and 91 seniors) divided into a dysphonic group and a non-dysphonic group. The protocol consisted of 18 questions and a score was calculated using a 10-cm visual analog scale. The measured value on the visual analog scale was added to the overall score, along with other partial scores. Speech samples allowed for analysis/assessment of the overall degree of vocal deviation and initial definition of the respective groups and after six months, the separation of the groups was confirmed using an acoustic analysis.RESULTS:The mean total scores were different between the groups in all samples. Values ranged between 37.0 and 57.85 in the dysphonic group and between 12.95 and 19.28 in the non-dysphonic group, with overall means of 46.09 and 15.55, respectively. High sensitivity and specificity were demonstrated when discriminating between the groups with the following cut-off points: 22.50 (children), 29.25 (adult women), 22.75 (adult men), and 27.10 (seniors).CONCLUSION:The protocol demonstrated high sensitivity and specificity in differentiating groups of individuals with and without dysphonia in different sample groups and is thus an effective instrument for use in voice clinics.

Correlation of the Dysphonia Severity Index (DSI), Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V), and Gender in Brazilians With and Without Voice Disorders

This study aims to analyze the Dysphonia Severity Index (DSI) in Brazilians with or without voice disorders and investigate DSI's correlation with gender and auditory-perceptual evaluation data obtained via the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) protocol. A total of 66 Brazilian adults from both genders participated in the study, including 24 patients with dysphonia confirmed on laryngeal examination (dysphonic group [DG]) and 42 volunteers without voice or hearing complaints and without auditory-perceptual voice disorders (nondysphonic group [NDG]). The vocal tasks included in CAPE-V and DSI were performed and recorded. Data were analyzed by means of the independent t test, the Mann-Whitney U test, and Pearson correlation at the 5% significance level. Differences were found in the mean DSI values between the DG and the NDG. Differences were also found in all DSI items between the groups, except for the highest frequency parameter. In the DG, a moderate negative correlation was detected between overall dysphonia severity (CAPE-V) and DSI value, and between breathiness and DSI value, and a weak negative correlation was detected between DSI value and roughness. In the NDG, the maximum phonation time was higher among males. In both groups, the highest frequency parameter was higher among females. The DSI discriminated among Brazilians with or without voice disorders. A correlation was found between some aspects of the DSI and the CAPE-V but not between DSI and gender.

Parents' Evaluations of Their Children's Dysphonia: The Mamas and the Papas

This study aimed to evaluate the validity and reliability of a Hebrew translation of the Pediatric Voice Handicap Index (pVHI). It also examined differences between mothers and fathers in evaluating their child's dysphonia. Observational design. The pVHI was first translated and adapted to Hebrew. The translated version was, then, administered to a group of 141 parents of children aged younger than 14years. Fifty-eight parents had a dysphonic child, and 83 had a nondysphonic child. Based on the parents' responses to the pVHI, statistical analyses were performed, evaluating validity and reliability, as well as group differences. Following, a subset of the participants, in which only cases where the responses of both parents were available, was examined for evaluating differences between the responses of mothers (n=46) and fathers (n=46). Statistical analyses revealed high reliability of the Hebrew version of the pVHI (Cronbach alpha=.97). Parents of the dysphonic children rated their children significantly higher than parents of the nondysphonic group (P<0.001). Mothers of the dysphonic children rated their children significantly higher than the fathers, on all subscales of the questionnaire (≥0.001 P<0.047). In contrast, no significant differences were found between mothers and fathers of the nondysphonic children (P>0.05). The Hebrew version of the pVHI is a reliable tool for quantifying parents' perception of their child's voice handicap. Mothers of dysphonic children evaluate their children's voice handicap more severely than fathers, whereas both parents of nondysphonic children perform this evaluation similarly.

Muscleskeletal pain in dysphonic women.

To investigate the location, frequency and intensity of muscle pain in dysphonic functional/organofunctional women in comparison to women with healthy voices. Sixty women, ranging in age from 18 to 45 years, divided into two groups: Dysphonic Group (DG) - 30 women with functional or organofunctional dysphonia; Non-Dysphonic Group (NDG) - 30 women without vocal complaints, and with adapted voices. All answered a protocol, marking the localization, frequency and intensity symptoms of pain on the temporal area, masseters, submandibular areas, larynx/pharynx, front and back of the neck, shoulders, upper back, lower back, elbows, fists/hands/fingers, hip/this, knees and ankles/feet. The volunteer should report the frequency in which pain was present in the last 12 months: no, rarely, frequently or always. The intensity of pain was measured by visual-analogue scales. The DG and NDG groups were compared using the Mann-Whitney test (p<0.05). The women of the DG reported significantly greater frequency of submandibular area (p=0.008), laryngeal pain (p<0.001), front of the neck (p=0.015), back of the neck (p=0.001), shoulder pain (p=0.027), upper back (p=0.027) and also reported significant greater intensity of pain in the larynx/pharynx (p=0.022) and back of the neck (p=0.003). The frequency and intensity of musculoskeletal pain was more frequent and more intense in dysphonic women than in women without vocal complaints, showing that pain may be related to functional and organofunctional dysphonia in women.

Voice Activity and Participation Profile Presenting Coordinates for Readjustment of Preventive Action of Educators

Purpose: To investigate the perception of voice impairment in professional and social contexts, to correlate these data with existing data in the literature, and to explore the perception of voice problems and the adherence to vocal health programs. Method: 502 Brazilian educators working in municipal public schools responded to the Voice Activity and Participation Profile (VAPP) questionnaire. Then a correlation was made with previous results in the literature dealing with a dysphonic and a nondysphonic group. Results: The VAPP data showed that self-perception of voice problems had a higher vocal impact on daily communication and lower scores for activity limitation and participation restriction. The educators’ scores were closer to those of the nondysphonic group with regard to daily and social communication, and emotional and activity limitation, but perception of the voice problem was closest to that of the dysphonic group. Nevertheless, the opposite was the case for participation restriction. Conclusions: The educators perceive vocal problems but do not perceive participation restriction to the same extent. This may explain the decreasing participation in the Vocal Health Program. It probably occurs because adults voluntarily apply for training when they feel that their work performance needs to improve so that they can carry out their job properly.

Comparing Health Locus of Control in Patients with Spasmodic Dysphonia, Functional Dysphonia and Nonlaryngeal Dystonia

Locus of Control (LoC) refers to an individuals' perception of whether they are in control of life events. Health Locus of Control refers to whether someone feels they have influence over their health. Health Locus of Control has not been studied in any depth in voice-disordered patients. The objective of this study was to examine Health Locus of Control in three patient groups: (1) Spasmodic Dysphonia, (2) Functional Dysphonia and (3) a nondysphonic group with Nonlaryngeal Dystonia. LoC was measured and compared in a total of 57 patients using the Multidimensional Health Locus of Control Scales (diagnostic specific) Form C. Internal, Chance, and Powerful others LoC were measured and comparisons were made using one-way analysis of variance. Contrary to expectations Internal LoC was found to be significantly higher in the Functional Dysphonia group when compared to the other two groups. There was no significant difference between the groups in Chance or Powerful others LoC. The two organic groups, Spasmodic Dysphonia and Nonlaryngeal Dystonia, were more alike in Internal Health Locus of Control than the Functional Dysphonia group. The diagnostic nature of the groups was reflected in their LoC scores rather than their voice loss. These results contribute to the debate about the etiology of Spasmodic Dysphonia and will be of interest to those involved in the psychology of voice and those managing voice-disordered patients.