Organic Dysphonia Research Articles

Effectiveness of Semi-Occluded Vocal Tract Exercises (SOVTEs) in Patients with Dysphonia: A Systematic Review and Meta-Analysis.

Dysphonia is a disorder characterized by an alteration in the overall quality of the voice which reduces quality of life. Therefore, we assessed the effectiveness of SOVTEs in the management of dysfunctional and organic dysphonia for acoustic, perceptual-auditive, aerodynamic parameters and self-perception of the disease. a systematic review and meta-analysis were conducted. Findings were reported according to the PRISMA statement. Five databases were searched for RCTs and non- or quasi-RCTs. Studies were independently assessed using the Cochrane Risk of bias (RoB) and ROBINS-I tools. Effect sizes (ES) were calculated only at post-treatment. GRADE criteria were used to assess the quality of evidence. eight articles were included. Studies investigated several SOVTEs, alone or in combination. None of the study was completely judged at low RoB. The quality of evidence resulted very low for each analysis. SOVTEs revealed to be statistically more effective than control interventions in improving F0 (ES: -14.42; CI 95%: -27.16, -1.69); P=0.03), whereas shimmer did not change significantly (ES: -0.43; CI 95%:-02.02, 1.15; P=0.59). Not significant changes in favor of control groups were found for jitter (ES: 0.13; CI 95%: -0.14, 0.40; P=0.34) and overall gravity in the perceptual-auditory evaluation (ES: 0.13 CI 95%: -0.50, 0.77; P=0. 68). Among secondary outcomes, evidence suggested that SOVTEs are more effective than control interventions in Psub reduction (ES: -1.47; CI 95%: -2.84, -0.10; P=0.03); self-assessment resulted not significantly in favor of SOVTEs (VHI/VRQoL: ES -0.23; CI 95% -1.14, 0.69; P=0.63 and VTDS/VDSI: ES -4.85, CI 95% -25.13, 15.42; P=0.64). results obtained showed that voice therapy based on SOVTEs is not to consider significantly superior if compared to other treatments, even if a favorable trend was detected and should be taken into consideration. Further high-quality RCTs on specific SOVTEs are recommended to produce better-quality evidence.

Functional and organic dysphonia in voice professionals (lecture)

An urgent task of otorhinolaryngology (phoniatry) is the diagnosis and treatment of disorders of voice function in voice professionals or persons of voice-speech professions. An undiagnosed laryngeal disease worsens the quality of life of patients, creates difficulties in communication and can even lead to professional unfitness, because the patient does not withstand the necessary vocal load. The leading role in the modern diagnosis of laryngeal diseases belongs to endoscopic research methods video endoscopy and video endostroboscopy. All disorders of voice function are classified as functional and organic. Recent studies have shown that from 30.5 to 40% of voice professionals who have applied for phoniatric care suffer from functional disorders. Functional changes are understood to mean changes in which laryngoscopic examination does not always reveal any visible pathology. But with the help of special research methods, such as stroboscopy (videostroboscopy), spectral analysis of the voice, pathognomonic changes can be determined, and the patient presents characteristic complaints. More often than others, hypotonic and hypo-hypertonic dysphonia are diagnosed. Organic laryngeal diseases are characteristic of 69.5% of patients with dysphonia. They are represented by various nosological forms. Certain difficulties arise in the diagnosis of professional laryngitis and vascular pathology of the larynx. The lecture presents pathognomonic clinical changes of the larynx in voice professionals, knowledge of which is necessary for practical doctors to make a diagnosis.

Treatment of relapsing functional and organic dysphonia: a narrative literature review.

Treatment of relapsing functional and organic dysphonia: a narrative literature review.

Video endoscopic methods of laryngeal examination in modern phoniatry

Introduction. Modern diagnostics of laryngeal diseases is based on the use of video endoscopic technologies. The authors of the article, having almost thirty years of experience with various methods of video endoscopy, proposed a classification of video endoscopic methods of laryngeal examination. Objective. To develop an algorithm for the application of various video endoscopic methods of laryngeal examination in voice professionals with functional and organic dysphonia. Materials and methods. From 2020 to 2022, 2308 patients aged 18 to 80 years (43.2 ± 11.5) were examined in the phoniatric department of the St. Petersburg Research Institute of ENT. There were 1424 women (61,7 %), 884 men (38,3 %) people. Functional dysphonia was detected in 705 (30,5 %) people, acute and chronic laryngitis in 668 (28,9 %), tumor-like formations in 436 (18,9 %), the remaining nosological forms were diagnosed in 499 (21,7). All the patients turned out to be representatives of voice-speaking professions and complained of dysphonia.For videolaryngoscopy, videolaryngostroboscopy, autofluorescence endoscopy, NBI–endoscopy, equipment from various manufacturers was used. Results. An algorithm for the application of video endoscopic research methods in persons of voice-speech professions with dysphonia has been developed. Overview videolaryngoscopy and videostroboscopy were mandatory research methods for all patients with complaints of voice function. The use of these two methods proved to be sufficient for the diagnosis of functional dysphonia, paresis and paralysis, congenital malformations of the larynx, scar stenosis. In-depth diagnostics and differential diagnostics of tumor-like formations, various forms of chronic laryngitis, benign and malignant formations, in addition to videolaryngoscopy and videostroboscopy, included autofluorescence endoscopy or NBI endoscopy, which revealed the earliest stages of the pathological process. Conclusions. Only the complex application of various methods of video endoscopy of the larynx provided timely diagnosis and early treatment of dysphonia, maximum restoration of voice function, and, consequently, the preservation of professional longevity by persons of voice-speech professions.

Voice Cloning Applied to Voice Disorders: a Study of Extreme Phonetic Content in Speaker Embeddings

Organic dysphonia can lead to vocal impairments. Recording patients' impaired voice could allow them to use voice cloning systems. In the domain of speech synthesis, voice cloning is the process of producing speech matching a target speaker voice, given textual input and an audio sample from the speaker. It can achieve high-quality speech with only few data from the target speaker. However, dysphonic patients may only produce speech with specific or limited phonetic content. To our knowledge, the impact of such constraints on a voice cloning system remains to be studied. This article presents the results of preliminary experiments on the matter, along with specifications about the models and datasets used.

A Comparison of Healthy and Disordered Voices Using Multi-Dimensional Voice Program, Praat, and TF32

Instrumental voice assessment plays a critical role in identifying vocal issues and for documenting treatment outcomes. The reported voice data, however, are sensitive to the algorithm used by each acoustic analysis software program (AASP) to analyze the corresponding waveform. In the present study, five acoustic measures were compared across healthy speakers and speakers with dysphonia for three AASPs commonly used in research, education, and clinical practice: Multidimensional Voice Program (MDVP) by Computerized Speech Lab, Praat, and TF32. Sustained vowel phonations for the quantal vowels /ɑ/, /i/, and /u/ were analyzed for 80 speakers with organic dysphonia and 60 age- and sex-matched healthy controls. Descriptive, inferential, and correlation data are reported for mean fundamental frequency (mean F0), standard deviation of fundamental frequency (SD F0), short-term perturbation measures of jitter and shimmer, and harmonic-to-noise ratio (HNR). The present study replicated previous findings of interprogram differences for healthy speakers, with MDVP consistently yielding higher values than Praat and TF32 for SD F0, jitter, and shimmer and lower values for HNR. Similar, but magnified patterns of results were observed for speakers with dysphonia. The variation observed across programs calls into question the validity in comparing voice outcomes reported by one AASP to those previously obtained by another, particularly for acoustic signals with aperiodic components that are commonly present in disordered voices. It is advised that waveforms be visually inspected prior to conducting acoustic analysis, and that voice outcomes not be combined or compared across AASPs.

Determinant of Voice Handicap Index Degree as Dysphonia Patients’ Quality of Life Indicator

Background: Dysphonia will interfere with communication which will have an impact on social life such as depression, disrupt activities, work and can affect the quality of life. Dysphonia risk factors such as age, sex, duration of illness and etiology will affect the course of it. The purpose of this study was to identify risk factors for with the degree of Voice Handicap Index (VHI) as an indicator of dysphonia patients.Methods: Analytical descriptive study with cross-sectional design in dysphonia patients, the sample was determined as many as 62 who met the inclusion criteria. Quality of life was assessed by the VHI questionnaire. VHI degrees are classified into mild and moderate-severe. Data analysis using chi-square test and multivariate logistic regression. Results:Thirty-two (51.6%) subjects were women. Mean age was 47.26 +12.2. The most common causes of dysphonia (85.5%) were due to organic disorders and laryngopharyngeal reflux (LPR) is the most common cause (37.1%) of all organic dysphonia disorders. Analysis of risk factors for age, gender, etiology of dysphonia and duration of illness with VHI degree were p = 0.282, p =0.76, p= 0.067, p= 0.001, respectively. Duration of illness ≥2 weeks has a 38.3x risk to severity VHI compared to <2 weeks. Conclusion: The duration of illness is a determinan related to of the degree of VHI that quality of life indicator in dysphonia patients.
 Key Words: Risk factors, Dysphonia, Voice Handicap Index

Linguistic adaptation and validation of the voice handicap index (VHI)-30 in patients with dysphonia into Russian

It is prospective observational study. The original English version of the VHI-30 questionnaire was translated into Russian by two independent researchers (professional translators). The final Russian version (VHI-30rus) was formulated by a third researcher (otorhinolaryngologist) on the basis of these two translations, and then translated back into English. The 181 participants were included in this study. The main group patients (n=91) were additionally divided into subgroups in accordance with the form of dysphonia: 65 (71.4%) patients had functional and organic dysphonia, 8 (8.8%) had chronic inflammatory diseases of the larynx, 7 (7.7%) - benign neoplasms of the larynx (singing nodules, polyps, cysts), 11 (12.1%) - unilateral laryngeal paralysis. The control group consisted of 90 people without voice disorders. Internal consistency (Cronbach's α coefficient), retest reliability (intraclass correlation coefficient (ICC) VHI-30, comparison of VHI-30 indicators of patients and studied control group (Mann-Whitney U-test, Kruskal-Wallis test) and correlation with the overall severity of dysphonia (Spearman's ρ rank correlation coefficient) were determined. In the patient group, we observed excellent internal consistency for VHI-30rus (α=0.95) and good internal consistency for all VHI-30rus subscales: physical (α=0.88), functional (α=0.88), and emotional (α=0.88). The intraclass correlation coefficient (ICC) indicated high retest reliability for patients (0.99) and control group subjects (0.84). The 30-item mean total values for patients with dysphonia were statistically significantly higher than for control group participants (p<0.001). A correlation was found between the overall VHI-30rus value and the overall severity of dysphonia (ρ=0.748, p<0.001). In the patient's group, female and male participants showed a statistically insignificant difference in the total value of VHI-30rus (Mann-Whitney U-test, p<0.001). There was a correlation in terms of VHI-30rus indicators in different subgroups of the patient group and the control group (Spearman's correlation coefficient: functional dysphonia - 0.942; chronic laryngitis - 0.756; unilateral laryngeal paralysis - 0.888; benign neoplasms - 0.982; control group studied - 0.882). As a result of this study, the VHI-30 questionnaire was translated from English into Russian for use in the Russian-speaking environment. The study showed good internal consistency, retest reliability, and clinical validity for the Russian version of the VHI-30rus questionnaire. The VHI-30rus questionnaire can be recommended for use in clinical practice for patients with dysphonia.

Acoustic and capacity analysis of the vocal organ in patients with functional and organic larynx disorders using the DiagnoScope Specialist software.

The aim of the study was to assess the acoustic and capacity analysis of singing voice using DiagnoScope Specialist software. The study was conducted in 131 adult subjects, including 74 women and 46 men aged 21-51, divided into 3 groups: I - 40 subjects (treatment group) - professional vocalists, II - 40 subjects (treatment group) - semiprofessional vocalists, III - 40 subjects (control group) - students of The Military Medical Faculty at the Medical University of Lodz - nonsingers. The research methodology included: primary medical history, physical examination (otolaryngological), videolaryngoscopic examination, the GRBAS scale for subjective voice evaluation, diagnostic voice acoustic and capacity analysis using DiagnoScope Specialist software, survey on lifestyle patterns which may affect voice quality. R esults: Average value of the fundamental frequency F0 was the highest in professional vocalists group; it was 316.46 Hz in women and 165.09 Hz in men. In semiprofessional vocalists group it was accordingly 260.50 Hz and 149.26 Hz, in nonsingers group it was accordingly 261.23 Hz and 159.27 Hz. The mean value of Jitter parameter in professional vocalists group was 0.30% in women and 0.54% in men, in semiprofessional vocalists group it was accordingly 0.31% and 0.57%, in nonsingers group it was 0.31% and 0.56%. The mean value of Shimmer parameter in professional vocalists group was 3.27% in women and 3.75% in men, in semiprofessional vocalists group it was accordingly 3.46% and 3.77%, in nonsingers group it was 4.33% and 4.39%. The mean value of the NHR index in professional vocalists group was 3.28% in women and 6.00% in men, in semiprofessional vocalists group it was accordingly 3.23% and 6.72%, in nonsingers group it was 3.89% and 6.13%. Values of the parameters which measure the character of the voice, relative period-to-period fundamental frequency perturbations, relative period-to-period amplitude perturbation and level of buzzing together with other methods have diagnostic and predictive value in early detection of voice disorders. Capacity analysis in singing voice showed very low values of the following parameters: phonation time, true phonation time, no phonation coefficient, voice efficiency coefficient and voice capacity.

Maximum phonation times and vital capacity in dysphonic women

ABSTRACT Objective: to verify the correlation between vital capacity and maximum phonation times of /ė/ (unvoiced) and /s/, as well as compare and relate them with the professional voice use and age in women with functional or organic-functional dysphonia. Methods: a retrospective research with 524 records of dysphonic patients from a school clinic, including young adult women with a speech-language diagnosis of functional or organic-functional dysphonia based on medical reports. Neurological and psychiatric alterations, previous speech therapy treatment, symptoms of flu or allergies on the day of evaluation, pulmonary disease, organic dysphonia diagnosis, and hearing loss, were excluded. The sample resulted in 14 women with functional dysphonia and 21 with organic-functional dysphonia. Data on professional voice use, as well as results for vital capacity and maximum phonation times were collected. The data were statistically analyzed at a 5% significance level. Results: There was a positive correlation for both groups of dysphonic patients between the maximum phonation times of /ė/ and of /s/, as well as the maximum phonation times of /ė/, /s/, and vital capacity. Higher values for vital capacity and maximum times of /s/ and /ė/ for voice professionals were seen. The maximum phonation times of /ė/ were lower than those of /s/. Conclusion: as the maximum phonation times of /ė/ increased, the maximum phonation times of /s/ and the vital capacity also augmented in both groups, demonstrating the interrelation among these variables; there was no relation with the other variables studied.

Convolutional Neural Networks for Pathological Voice Detection.

Acoustic analysis using signal processing tools can be used to extract voice features to distinguish whether a voice is pathological or healthy. The proposed work uses spectrogram of voice recordings from a voice database as the input to a Convolutional Neural Network (CNN) for automatic feature extraction and classification of disordered and normal voice. The novel classifier achieved 88.5%, 66.2% and 77.0% accuracy on training, validation and testing data set respectively on 482 normal and 482 organic dysphonia speech files. It reveals that the proposed novel algorithm on the Saarbruecken Voice Database can effectively been used for screening pathological voice recordings.

Objective measurement of mucosal wave parameters in diagnosing benign lesions of the vocal folds

Introduction: The diagnostic procedure of phonation is dominated by subjective assessment tools. It seems reasonable to seek methods of quantitative glottal cycle assessment.Objective: The aim of our study was the analysis of open quotients (OQ) of the glottis.Methods: One hundred and twenty-four people were included in the study. Methodology was based on tools available in everyday phoniatrics practice – laryngovideostroboscopy (LVS) and electroglottography (EGG). There were statistically significant differences between control and studied group. Vocal fold polyps, nodules and edema influence glottal function in a different manner, what can be illustrated by objective glottal function parameters. Establishing Videostroboscopic Open Quotient values from three parts of glottis and Electroglottographic Quasi Open Quotient (QOQ) value, can help in dividing patients with benign lesions of vocal folds according to the type of disease.Results and conclusions: Measurement of the open quotient from three parts of the glottis helps to differentially diagnose and localize glottal vocal fold lesions. Videostroboscopic Open Quotient and Electroglottographic QOQ values can be used to quantify the glottal cycle. Videostroboscopic Open Quotient, Electroglottographic QOQ and their ratio varies depending on the type of organic dysphonia.

Voice deviation, dysphonia risk screening and quality of life in individuals with various laryngeal diagnoses

OBJECTIVES:To characterize the voice quality of individuals with dysphonia and to investigate possible correlations between the degree of voice deviation (D) and scores on the Dysphonia Risk Screening Protocol-General (DRSP), the Voice-Related Quality of Life (V-RQOL) measure and the Voice Handicap Index, short version (VHI-10).METHODS:The sample included 200 individuals with dysphonia. Following laryngoscopy, the participants completed the DRSP, the V-RQOL measure, and the VHI-10; subsequently, voice samples were recorded for auditory-perceptual and acoustic analyses. The correlation between the score for each questionnaire and the overall degree of vocal deviation was analyzed, as was the correlation among the scores for the three questionnaires.RESULTS:Most of the participants (62%) were female, and the mean age of the sample was 49 years. The most common laryngeal diagnosis was organic dysphonia (79.5%). The mean D was 59.54, and the predominance of roughness had a mean of 54.74. All the participants exhibited at least one abnormal acoustic aspect. The mean questionnaire scores were DRSP, 44.7; V-RQOL, 57.1; and VHI-10, 16. An inverse correlation was found between the V-RQOL score and D; however, a positive correlation was found between both the VHI-10 and DRSP scores and D.CONCLUSION:A predominance of adult women, organic dysphonia, moderate voice deviation, high dysphonia risk, and low to moderate quality of life impact characterized our sample. There were correlations between the scores of each of the three questionnaires and the degree of voice deviation. It should be noted that the DRSP monitored the degree of dysphonia severity, which reinforces its applicability for patients with different laryngeal diagnoses.

Usefulness of high-speed digital imaging (HSDI) in the diagnosis of oedematous - hypertrophic changes of the larynx in people using voice occupationally.

The aim of the study is the evaluation of the usefulness of High-Speed Digital Imaging (HSDI) in the diagnosis of organic dysphonia in a form of oedematous-hypertrophic changes of vocal fold mucosa, morphologically confirmed by Transmission Electron Microscopy (TEM) method in patients working with voice occupationally. The group consisted of 30 patients working with voice occupationally with oedematous-hypertrophic changes of vocal fold mucosa. Parameters of vocal folds vibrations were evaluated using HSDI technique with a digital HS camera, HRES Endocam Richard Wolf GmbH. The image of vocal folds was recorded with a rate of 4000 frames per second. Postoperative material of the larynx was prepared in a routine way and observed in transmission electron microscope OPTON 900-PC. HSDI technique allows to assess the real vibrations of vocal folds and determine many parameters. The results of TEM in the postoperative material showed destruction of epithelial cells with severe vacuolar degeneration, the enlargement of intercellular spaces and a large number of blood vessels in the stroma, which indicates the presence of oedematous-hypertrophic changes of the larynx. The ultrastructural assessment confirm the particular usefulness of HSDI method in the diagnosis of organic dysphonia in a form of oedematous-hypertrophic changes. Key words: High-Speed Digital Imaging, oedematous-hypertrophic changes, vocal fold mucosa, larynx.

Stabilometric findings in patients affected by organic dysphonia before and after phonomicrosurgery.

SUMMARYThe purpose of this study is to understand if there is any alteration in the posture of patients affected by organic dysphonia and describe possible postural modifications after phonomicrosurgery on the vocal folds. Forty subjects (22 males, 18 females; mean age 32.6 ± 7.5 years) suffering from organic dysphonia (15 cases of polyps, 11 submucosal retention cysts, 10 bilateral fibrous vocal fold nodules and 4 bilateral Reinke's oedema) were examined by open-eye and closed-eye posturography while breathing spontaneously before surgery, 24 hours after surgery and after 6 months. The variables taken into account were: the coordinates of the centre of pressure on both frontal and sagittal planes, length and surface of the track, mean velocity of the oscillations and relative standard deviations, spectral analysis of oscillation frequency, statokinesigram and stabilogram values. No characteristic pathological pattern was seen in basal stabilometry in any of the subgroups (polyps, cysts, Reinke's oedema). Only the subgroup of patients with fibrous vocal fold nodules (8/10; 80%) showed a slight forward shift from the centre of gravity when analysed in both open-eye and closed-eye posturography. A comparison performed within the same subgroup using open-eye and closed-eye posturography before and after surgery revealed no significant difference in any of the parameters being studied. The use of static stabilometry in this study demonstrates the absence of characteristic postural alterations in patients affected by organic dysphonia and also excludes that simple removal of the vocal fold lesion can change posture.

Terapia breve e intensiva com finger kazoo em caso de disfonia orgânica pós-intubação orotraqueal

Objetivo: avaliar o efeito de um programa de Terapia Breve e Intensiva com a técnica finger kazoo em paciente adulta do sexo feminino com disfonia orgânica. Apresentação do caso clínico: realizadas medidas aerodinâmicas, acústicas, perceptivoauditivas, videolaringoestroboscópicas e autoavaliação vocal antes e após 15 sessões de terapia breve e intensiva com a técnica finger kazzo em uma mulher de 62 anos com disfonia orgânica por fibrose em prega vocal direita, fenda glótica do tipo irregular, com assimetria de fase e amplitude, além de edema da subglote e retração da porção anterior da prega vestibular direita decorrente de intubação orotraqueal. Após a terapia, houve melhora dos tempos máximos de fonação, de medidas acústicas de frequência, perturbação de frequência, ruído, segmentos sub-harmônicos, melhora do traçado espectrográfico e de todos os parâmetros perceptivoauditivos, além de melhora dos escores de qualidade de vida, de depressão e ansiedade. Na avaliação videolaringoestroboscópica, houve melhora da amplitude de vibração da mucosa das pregas vocais e redução da constrição medial do vestíbulo laríngeo. Conclusão: houve modificações vocais positivas em nível glótico, respiratório e ressonantal, bem como no exame videolaringoestroboscópico e na autoavaliação vocal, evidenciando que essa foi uma modalidade de tratamento efetiva para o caso.

Association between the adherence to voice therapy and voice activity profile in patients with behavioral dysphony.

To analyze the association between adherence to voice therapy and voice activity profile in patients with behavioral dysphonia and possible associated factors. The study included eighteen individuals with behavioral dysphonia who were on regular treatment at the institution Hearing and Speech Therapy Service. The participants of this study responded to the Voice Activity and Participation Profile Protocol (VAPP) and URICA-VOICE scale. The associated variables (number of sessions, age, type of behavioral dysphonia, gender and previous speech therapy) were collected through interviews with patients and analysis of their medical records. The data were submitted to inferential statistical analysis. Most patients were in the action stage. There was a statistically significant association between the aspect of the VAPP Effects on Emotion and stages of readiness for adherence to voice therapy, but other VAPP aspects were not associated with the URICA-VOICE scale. Regarding the associated variables, the number of sessions, age and type of behavioral dysphonia were associated with the adherence to voice therapy. There was a statistically significant difference between the type of behavioral dysphonia and VAPP scores. The aspect of VAPP Effects on Emotion and variables such as number of sessions, age and type of dysphonia were associated to the URICA-VOICE scale adherence stage. Individuals with organic dysphonia had greater impact of vocal disorders in their daily activities.

The influence of vocal fold mass lesions on the passaggio region of professional singers.

In professional classical singing, an even voice quality throughout the entire singing voice range is essential. Transitions between vocal registers (passaggio) are the technically most challenging aspects in classical singing. It is hypothesized that they are most affected by vocal fold mass lesions (VFML). Cohort study. In this study, the effect of VFML on vocal fold vibration in the passaggio regions was analyzed in four female and three male singers suffering from organic dysphonia. The singers were asked to sing an ascending glissando through the passaggio regions, before and after treatment. The vocal fold vibration was documented with transnasal endoscopic high-speed imaging recordings at 20,000 frames per second, supplemented by synchronized acoustic and electroglottographic recordings. Major irregularities were found in the passaggio region of four singers before treatment, whereas the respective phonations below the passaggio were almost regular. In two female singers only the upper, but not the lower passaggio was affected. In all four of these participants, the passaggio region was more regular after treatment. In the remaining three participants, the VFML showed no effect on the passaggio region. However, the singers' ability to reach higher pitches was impaired, but was resolved after treatment. The data in this case study strongly suggest that the passaggio region could be affected by VFML, even if phonation outside the passaggio regions is unimpaired. When planning surgical procedures for professional singers, clinical examination protocols should therefore include phonatory tests across the passaggio regions. 4 Laryngoscope, 127:1392-1401, 2017.

The Relationship Between the Aerodynamic Parameters of Voice and Perceptual Evaluation in the Iranian Population With or Without Voice Disorders

Aerodynamic evaluations can provide useful information about the interaction between the respiratory and the phonation systems. The present study was conducted to investigate the relationship of maximum phonation time (MPT), vital capacity (VC), and phonation quotient (PQ) with perceptual evaluation in different types of dysphonia. The relationship between these parameters and the type of dysphonia was also examined. The study participants consisted of 300 individuals with different types of dysphonia (104 women and 196 men) and 100 healthy samples (63 women and 37 men). A professional speech-language pathologist conducted the perceptual evaluation based on the G (grade) component of the GRBAS scale, which stands for grade, roughness, breathiness, asthenia, and strain. VC was measured using a spirometer and MPT using a stopwatch. PQ was calculated as the ratio of VC to MPT. The difference between the mean ± standard deviation of PQ, VC, and MPT were found to be significant at all the four degrees of dysphonia severity (P < 0.001). There was a significant difference in mean MPT and VC between the genders (P < 0.001), but no significant gender differences were observed in terms of the mean PQ (P = 0.346). The study participants were classified into four groups, including the organic dysphonia group, neurologic dysphonia and functional dysphonia groups, and the normal group; the study variables measured were found to be significantly different between all the four groups (P < 0.001). As MPT and PQ were correlated with the perceptual G (grade) and differentiated dysphonic from healthy individuals, clinicians are recommended to take account of them in their instrumental evaluations.

Voice Self-assessment Protocols: Different Trends Among Organic and Behavioral Dysphonias

This study aimed to correlate the results of five self-assessment instruments for patients with behavioral or organic dysphonia (OD), and to analyze their relationship with listeners' judgments of degree of voice severity and predominant type of voice deviation. This is a cross-sectional prospective study. A total of 103 patients (77 with behavioral dysphonia, 26 with OD) completed the Brazilian validated versions of five instruments: Voice Handicap Index (VHI), Voice-Related Quality of Life, Vocal Performance Questionnaire, Voice Symptom Scale (VoiSS), and Vocal Tract Discomfort Scale. Voice samples were collected for auditory-perceptual analysis. Correlations were made among protocols, and between these instruments and the perceptual analysis. None of the instruments correctly identified 100% of the dysphonic individuals. The VoiSS identified 100 of the 103 subjects. Numerous correlations were found with variable strength. The strongest correlation was between frequency and severity scales of the Vocal Tract Discomfort Scale (r = 0.946) and the total score of the VHI and VoiSS (r = 0.917). Correlations between the instruments and the perceptual analysis achieved only moderate strength; the VHI, the Voice-Related Quality of Life, and the VoiSS showed the highest correlations with counting numbers task, particularly for OD. The predominant type of voice deviation did not influence the score of the protocols. None of the self-assessment instruments is capable of identifying all cases of dysphonia. However, they are important in assessing the impact of voice problem on quality of life. Patient self-assessment and clinician perceptual evaluation share only moderate correlations, with higher strength for counting numbers task in comparison with sustained vowel.