Perceptual Evaluation Of Voice Quality Research Articles

The Impact of Surgical Technique and Extent of Thyroidectomy in Voice Outcomes a Prospective Study

This prospective study aimed to evaluate the impact of surgical technique and extent of thyroidectomy on voice outcomes in 46 patients undergoing thyroidectomy. Patients were divided into three groups: limited thyroidectomy (n=20), total thyroidectomy (n=19), and extended thyroidectomy (n=7). Voice assessments were performed preoperatively and at 3 and 6 months postoperatively. Results showed that the surgical technique and extent of thyroidectomy had no significant effect on voice outcomes. However, a greater proportion of patients with limited thyroidectomy experienced a decrease in voice quality at three months postoperatively compared to patients with total or extended thyroidectomy. This study suggests that surgical technique and extent of thyroidectomy do not significantly affect voice outcomes in the long term. Further research is needed to understand these factors' impact on voice outcomes. Methodology: This prospective study was conducted in the department of surgery hmc Peshawar from Jan 2020 to Jan 2021 over the 01 years of a pride sample size of 46 patients (30 male and 16 female) who underwent thyroidectomy. Patients were divided into three groups based on the surgical technique and extent of thyroidectomy: limited thyroidectomy (n=20), total thyroidectomy (n=19), and extended thyroidectomy (n=7). All patients underwent preoperative and postoperative voice assessments at 3 and 6 months. The assessments included acoustic analysis and perceptual evaluation of voice quality. Results were compared between the three groups to evaluate the surgical technique's impact and thyroidectomy's extent on voice outcomes. Statistical analysis was performed to analyze the data. Results: The results showed that the surgical technique and extent of thyroidectomy had no significant effect on voice outcomes. However, a greater proportion of patients with limited thyroidectomy experienced a decrease in voice quality at three months postoperatively, compared to patients with total or extended thyroidectomy results shown in tables 1 to 7. Conclusion: This study suggests that surgical technique and extent of thyroidectomy do not significantly affect voice outcomes in the long term. Further research is needed to understand these factors' impact on voice outcomes. keywords: thyroidectomy, voice outcomes, surgical technique, the extent of thyroidectomy

Validation of Acoustic Breathiness Index (ABI) in the South Indian Population

Acoustic Breathiness Index (ABI) is an acoustic model which equates to the auditory-perceptual (A-P) measure of breathiness. Globally, ABI has been validated in multiple languages. To date, empirical studies validating ABI in the South Indian population have not been carried out. Moreover, there is only minimal evidence on the impact of language and gender on ABI. This study attempted to validate ABI in languages of Malayalam and Kannada with "B" and "G" of GRBAS. The authors also examined the influence of language and gender on ABI. The authors retrospectively analyzed a dataset consisting of 160 voice samples (91 normophonic and 69 dysphonic). Five speech-language pathologists perceptually evaluated these samples on the GRBAS scale. PRAAT software was used to calculate ABI for each voice sample. The authors also determined the effects of language and gender on ABI. Following this, ABI's concurrent validity and diagnostic accuracy were examined relating to "B" and "G" of the GRBAS scale. The judges reached a moderate agreement on the perceptual evaluation of voice quality. The authors observed neither language nor gender differences in ABI. The concurrent validity of ABI was strong (r=0.761) when correlated against "B". Further, evaluations revealed that an ABI value of >3.66 could distinguish between breathy and non-breathy voice samples with an area under the curve of 0.816 (Sensitivity=61.73%; Specificity=94.93%). On the other hand, the concurrent validity of ABI in correlation with "G" did not yield the optimal result. ABI is a valid acoustic tool for identifying breathiness in the languages of Malayalam and Kannada. ABI correlates better with "B" than "G" on the GRBAS scale. ABI is independent of language and gender.

Voice and Swallowing Disorders After Thyroid Surgery

The aim of the study was to evaluate voice and swallowing function following thyroid surgery, to identify dynamic changes during the follow-up period of 12-18 month and to find possible indicative signs of permanent or temporary vocal fold palsy. All participants (N = 110) were prospectively enrolled from the preoperative thyroid surgery patients between September 2013 and December 2016. All subjects underwent preoperatively, first week and 12-18 month postoperatively videolaryngostroboscopy, filled in subjective evaluation of voice (voice handicap index, [VHI]) and swallowing (swallowing impairment score) complaints. Acoustic voice analysis (AVA), maximum phonation time (MPT) measurement and perceptual voice evaluation were conducted. In the presence of laryngeal damage, additional first and sixth-month follow-up visits were planned. Patients, whom we suspected laryngeal nerve damage, underwent laryngeal electromyography 4 weeks after the operation. On first postoperative week evaluation, no objective voice changes within patients with postoperatively intact laryngeal nerves were found. Subjective evaluations showed decline in VHI physical domain and increased strain in postoperative voice. Patients with postoperative nerve damage had a drastic decline in subjective voice quality (VHI all subscales and total score), AVA parameter jitter, MPT and perceptual voice quality. Subjective evaluation of swallowing revealed disturbances in all patients regardless of the nerve damage. We noticed remarkable differences in first week and first month visits between patients with permanent and temporary palsy in VHI total score and physical domain, MPT and perceptual breathiness and asthenia in voice. Regardless of the nerve injury, by the end of the follow-up period all changes had become statistically insignificant with the exception of perceptual evaluation of voice quality. Patients with postoperative laryngeal nerve damage experience substantial deterioration of both subjective and objective voice quality with more extensive impairment in patients with permanent paralysis. Thyroid surgery causes subjective swallowing changes irrespective of laryngeal nerve damage. In patients without laryngeal nerve damage, swallowing function improves following thyroidectomy. Possible indicators for permanent paralysis are delayed recovery in the values of MPT and jitter and persistent perceptual breathiness and asthenia.

Comparison and Validation of Acoustic Voice Quality Index Version 2 and Version 3 among South Indian Population

Acoustic Voice Quality Index (AVQI) has emerged in the recent past as a robust multiparametric voice quality evaluation tool. Two versions of AVQI derived using the program PRAAT have found extensive clinical and research applications. These versions have been validated in several languages around the world. However, no research reports are available on validation of AVQI in the South Indian population. Further, studies comparing the performance of the two versions of AVQI are limited in the literature. This study was designed to validate and compare the two versions of AVQI (AVQIv02.02 and AVQIv03.01) in South Indian languages (Malayalam and Kannada). A retrospective analysis of previously recorded voice samples was carried out on a total of 160 (91 normophonic and 69 dysphonic) voice samples. These samples were perceptually rated on a GRBAS scale by five experienced speech-language pathologists. Standardized Syllable Number (SSN) necessary to derive AVQIv03.01 was computed. Following this, these samples were analyzed to obtain the AVQIv02.02 and AVQIv03.01. The concurrent validity and diagnostic accuracy of these measures were then examined and compared. A moderate agreement was obtained across the judges on perceptual evaluation of voice quality. SSN in Malayalam and Kannada languages were identified to be 29 and 25 syllables respectively. Language differences were not observed on both versions of AVQI. The concurrent validity of AVQIv03.01 (r = 0.788) was superior to that of AVQIv02.02 (r = 0.655). Further, the threshold of differentiating normophonic and dysphonic samples were determined to be >3.45 for AVQIv02.02 and >2.45 for AVQIv03.01. AVQIv03.01 is superior to AVQIv02.02 in terms of its diagnostic accuracy and concurrent validity. Current findings also extend the application of AVQI as a robust tool for the evaluation of voice characteristics to the South Indian population.

Multi-dimensional investigation of the clinical effectiveness and prognostic factors of voice therapy for benign voice disorders

Voice therapy is frequently recommended as the first-line treatment for benign voice disorders. This study investigated the clinical effectiveness of voice therapy and the prognostic factors of treatment outcomes. We recruited 103 consecutive patients with voice disorders, namely vocal nodules, polyps, and muscle tension dysphonia (MTD), from September 2014 to July 2016. All the patients received voice therapy as the primary treatment. Treatment outcomes were evaluated using auditory perceptual evaluation, acoustic analysis, maximum phonation time, and 10-item voice handicap index (VHI-10). Clinical effectiveness of voice therapy was defined by either 1) a posttreatment VHI-10 score ≤ 10 points or 2) decline of VHI-10 ≥ 4 points. After voice therapy, VHI-10 and perceptual rating of voice quality improved significantly (p<0.05) in the three disease categories. In patients with nodules, all the outcome parameters improved significantly (p<0.05). Patients with good adherence to voice therapy (attending more than four sessions) had a significantly higher effectiveness than those with poor adherence (87% vs. 64%, p<0.05). Patients with high occupational vocal demand also demonstrated a better effectiveness than those with routine vocal demand (90% vs. 70%, p<0.05). Subsequent multivariate analyses revealed that adherence and vocal demand were independently and significantly correlated with clinical effectiveness (p=0.03). Voice therapy is effective for patients with vocal nodules, polyps, and MTD. Adherence to voice therapy and occupational vocal demand are significant prognostic factors for treatment outcomes.

Outcomes of voice therapy in children with benign vocal fold lesions

ObjectiveThis study aims to examine the effect of voice therapy on dysphonia on children with benign vocal fold lesions, as measured by perceptual evaluation using the Consensus Auditory Perceptual Evaluation of Voice (CAPE-V) and acoustic and aerodynamic measures (jitter, shimmer, noise-to-harmonic ratio, phonation threshold pressure, mean airflow during voicing, subglottic pressure during comfortable phonation). Study designProspective disease-specific outcomes database. MethodsSubjects identified in the database consisted of 28 children (14 male, 14 female) between the ages of three and eighteen. Pre- and post-therapy perceptual, acoustic and aerodynamic measures were compared using two-sided paired t-test. ResultsThere was a statistically significant difference in perceptual ratings of voice quality (p < .001) and in phonation threshold pressure before and after therapy (p = .034). While acoustic measures improved after therapy, changes were not statistically significant. ConclusionsChildren with dysphonia secondary to benign vocal fold lesions showed positive change in perceptual ratings of voice quality and in phonation threshold pressure after voice therapy.

Voice Therapy Outcome—A Randomized Clinical Trial Comparing Individual Voice Therapy, Therapy in Group, and Controls Without Therapy

ObjectiveA stumbling-block in voice therapy is how the patient will be able to apply the new voice technique in everyday life. Possibly this generalization process could be facilitated by giving voice therapy in group because of the natural forum for training voice-to-speech early in communication between the patients in a group setting. The aim of the study was to compare treatment results from individual voice therapy and voice therapy in group, at several time points and in comparison to patients with no voice therapy. MethodsA randomized treatment study was performed with 77 consecutive patients diagnosed with a functional voice disorder. Thirty-one patients were randomized to individual and group therapy, respectively, and 15 patients to no therapy. The assessments included standardized voice recording and registration of voice range profile (VRP), answering Voice handicap index (VHI) and visual analogue scales for self-hoarseness and self-vocal fatigue, and perceptual voice evaluation by speech-language pathologist. The assessments were performed before, direct after therapy, and three months later in all groups. The 2 therapy groups were also assessed 12 months after therapy. ResultsAll VHI scores as well as the self-ratings of hoarseness and vocal fatigue, and the perceptual evaluation of voice quality and maximum VRP improved significantly in both therapy groups 3 months after treatment and at 12 months follow-up. There were no significant changes in the control group, with the exception of decreased self-rated hoarseness and increased maximum VRP. Comparisons between treatment groups showed significant larger improvement after group therapy for VHI physical subscale at 12 months, as well as significant lower VHI total score at all measurement sessions and lower subscale scores at 12 months. There were no differences between treatment groups in self-hoarseness or self-vocal fatigue and no difference in perceptual voice quality or VRP. Comparison between controls and treatment groups showed significant larger change in treatment groups from baseline to three months in VHI total and to end of therapy in functional subscale. Treatment groups also showed significant lower scores than controls at each measurement session, for VHI total and physical subscale as well as lower degree of perceptual aberration of voice quality and vocal fatigue, at three months follow-up. ConclusionsThis study shows long-term improvement from behavioral voice therapy, particularly in a group setting. The results indicate the importance of early transfer-to-speech and late posttherapy test to capture whether the goal of voice therapy was fulfilled or not for the patients.

Perceptual Evaluation of Voice Disorder in Children Who Have Had Laryngotracheal Reconstruction Surgery and the Relationship Between Clinician Perceptual Ratingof Voice Quality and Parent Proxy/Child Self-Report of Voice-Related Quality of Life

Reliability of the GRBAS tool for perceptual evaluation of paediatric voice disorder is measured in this study of children with a history of laryngotracheal reconstruction surgery (LTR). Additionally, the relationship between parent proxy/child self-report of voice-related quality of life with clinician perceptual rating of voice quality is analysed. Eleven children with a history of LTR provided voice recordings following the stimuli set by the CAPE-V protocol. Subjective impact of voice quality on life was measured using the paediatric voice-related quality of life questionnaire. Four trained judges rated the sound files according to both the GRBAS and CAPE-V protocol. Intra-class correlation coefficients were high for both intra-rater and inter-rater judgments across all parameters of the GRBAS protocol, and a strong correlation was found between the grade rating of the GRBAS and the overall severity rating of the CAPE-V. Some elements of parent proxy reporting of voice-related quality of life were significantly negatively correlated with clinician perceptual rating of voice quality, while there was no significant relationship between child self-report and clinician perceptual rating.

Treatment Outcomes and Adverse Events Following In-Office Angiolytic Laser With or Without Concurrent Polypectomy for Vocal Fold Polyps

In-office angiolytic laser procedures have been used successfully as an alternative treatment for vocal fold polyps; little is known in detail about the treatment outcomes and adverse events. To examine the outcomes and incidence rates of adverse events associated with in-office angiolytic laser procedures with or without concurrent polypectomy as an alternative treatment for vocal fold polyps. Retrospective cohort study at a tertiary medical center. We identified 114 consecutive patients with vocal polyps who underwent in-office angiolytic laser treatments between January 1, 2014, and August 31, 2016. After the exclusion of 17 with missing or incomplete data, 97 were enrolled. In-office 532-nm laser procedures with or without concurrent polypectomy. Between 1 and 2 months after the surgical procedures, we collected the following outcome data: videolaryngostroboscopy, perceptual rating of voice quality, acoustic analysis, maximal phonation time, and subjective rating of voice quality using a visual analogue scale and 10-item voice handicap index. This study enrolled 97 patients (mean [SD] age, 45.6 [11.3] years; 48 [49%] male). The mean duration of symptoms was 10.1 months (range, 1-60 months). Twenty-nine patients (30%) had angiolytic laser procedures only, while 68 (70%) received laser with concurrent polypectomy. Both treatment modalities offered significant improvements. Only 1 patient (1%) receiving angiolytic laser with concurrent polypectomy underwent another treatment session, so this group had significantly less need for multiple treatments than those receiving laser treatment alone (6 [21%]; effect size, -1.57; 95% CI, -2.77 to -0.36). We identified 8 adverse events (8% of the cases): vocal fold edema (n = 5), vocal hematoma (n = 2), and vocal ulceration (n = 1). Patients treated with laser plus concurrent polypectomy had significantly fewer adverse events than those treated with angiolytic laser alone (2 [3%] vs 6 [21%]; effect size, 1.20; 95% CI, 0.26 to 2.13). In-office angiolytic laser procedures can be an effective alternative treatment for vocal polyps, although with possible need for multiple treatment sessions and occasional occurrence of minor postoperative adverse events. Concurrent polypectomy following laser coagulation allows less laser energy delivery and reduces the risk of postoperative adverse events and the need for additional treatment sessions.

Measuring Vocal Fatigue in Sports Coaches

Objective: This study explores the immediate impact of prolonged voice use by professional sports coaches. Method: Speech samples including sustained phonation of vowel /a/ and a short read passage were collected from two professional sports coaches. The audio recordings were made within an hour before and after a coaching session, over three sessions. Perceptual evaluation of voice quality was done using the GRBAS scale. The speech samples were subsequently analyzed using Praat. The acoustic measures included fundamental frequency (f0), jitter, shimmer, Harmonics-to-Noise ratio and Cepstral Peak Prominence. Main results: The results of perceptual and acoustic analysis suggest a slight shift towards a tenser phonation post-coaching session, which is a likely consequence of laryngeal muscle adaptation to prolonged voice use. This tendency was similar in sustained vowels and connected speech. Conclusion: Acoustic measures used in this study can be useful to capture the voice change post-coaching session. It is desirable, however, that more sophisticated and robust and at the same time intuitive and easy-to-use tools for voice assessment and monitoring be made available to clinicians and professional voice users.

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

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

Evaluation of Phonatory Behavior and Voice Quality in Patients with Multiple Sclerosis Treated with Deep Brain Stimulation

The effect of deep brain stimulation (DBS) on phonatory behavior and voice quality in eight patients with multiple sclerosis (MS) was examined instrumentally and perceptually. The acoustic signals of vowel productions obtained from patients (produced with and without stimulation) and from a group of 16 healthy control speakers were analyzed to prove statistically the changes of phonatory behavior and voice quality. This is a randomized study. Firstly, a new parametrization was used to determine phonatory behavior. Secondly, a perceptual evaluation of voice quality of the same speech material was performed. With stimulation, phonation has a greater tendency to be strained. The results of perceptual evaluation support this strained phonation behavior under stimulation, resulting in a smaller degree of breathiness ratings of all raters. Without stimulation, an impaired and partly disturbed adduction of the vocal folds can be shown. These findings are also supported in the perceptual experiment providing a higher degree of hoarseness ratings of all raters for these signals. High-frequency electrical impulses to the thalamus in patients with MS influence the phonatory behavior of their vocal folds. The results suggest the need for long-term monitoring of phonatory behavior during DBS to initiate adequate treatments without delay.

Listeners’ identification and evaluation of Korean idiomatic utterances produced by persons with left- or right-hemisphere damage

ABSTRACTThis study investigates the effects of left- (LHD) or right-hemisphere damage (RHD) on the production of matched idiomatic or literal expressions by examining healthy listeners’ abilities to identify, evaluate and perceptually characterize the utterances. Native speakers of Korean with LHD or RHD and healthy controls (HCs) produced six ditropically ambiguous (idiomatic or literal) sentences in an elicitation and a repetition task. Healthy listeners identified the sentence types and indicated how well each utterance represented the intended meaning. Perceptual ratings of voice quality were performed by expert listeners. The results indicate a negative effect of RHD on listeners’ identification and goodness ratings of utterance type. Repetition yielded better speech exemplars than elicitation. Sentence type was associated with selected voice qualities. These findings support previous reports of prosodic information serving to signal idiomatic versus literal meanings as well as a right-hemisphere involvement in formulaic language and the dual process model of language.

Spectral-normalization filter for subjective analysis of the aging voice.

Voice quality changes with age. In many cases, these voice changes result in a lower quality of life. Because one way of identifying these voice quality changes is through perceptually estimating talker age, correlations made between estimated talker age and acoustic analysis can provide insight to the possible physiological degeneration related to vocal function. While most perceptual studies investigating estimated talker age are cross-sectional, a longitudinal study of single speakers could provide additional details in the progressive degeneration of the voice quality. Nevertheless, one limitation of these studies is that perceptual ratings of voice quality or talker age in a longitudinal study could be biased by recording quality. Further, the spectral qualities of recordings from earlier decades are limited by the technology used. In this paper, a spectral-normalization filter was developed and applied to a corpus of recordings from an individual spanning about 50 years (1959 - 2007) to reduce this impact of these limitations. The filter was shown to be effective in normalizing the autospectra of the recordings and the fundamental frequency was unaffected by the filter. Preliminary subjective analysis suggests that the recording quality of all the files were perceptually similar.

Comparative Effectiveness of Office‐Based 532‐nm Laser‐Assisted Vocal Polypectomy and Phonomicrosurgery: A Matched Cohort Study

Objectives: Office-based procedures, including indirect laryngoscopic surgery and angiolytic laser photocoagulation, have been proposed to treat hemorrhagic vocal polyps. Our previous research documented good treatment outcomes by combining the 2 aforementioned procedures (laser-assisted vocal polypectomy [LAVP]). This study intends to further compare the effectiveness of LAVP with the gold standard of phonomicrosurgery. Methods: This study retrospectively enrolled 50 age-, sex-, and size-matched patients of hemorrhagic vocal polyps treated by LAVP or phonomicrosurgery at a tertiary teaching hospital from January 2012 to October 2013. Treatment outcomes were evaluated before, 2 weeks after, and 6 weeks after the procedures via perceptual rating of voice quality, acoustic measurement of the speech signal, 10-item voice-handicap index (VHI-10), maximal phonation time (MPT), subjective rating of voice quality, and videolaryngostroboscopic evaluations. Results: Both LAVP and phonomicrosurgery demonstrated significant improvements in most measuring parameters, 2 and 6 weeks postoperatively. Comparative effectiveness demonstrated similar objective outcomes (MPT, VHI-10, perceptual, endoscopic, and acoustic analyses) between LAVP and phonomicrosurgery, while patients who received LAVP reported more symptomatic relief and higher subjective voice quality then phonomicrosurgery 2 weeks postoperatively. Six weeks after the procedures, both objective and subjective effectiveness revealed non-significant differences between the 2 treatment groups. Conclusions: This study demonstrated that office-based 532-nm LAVP can be an effective, practical, and safe alternative treatment for small hemorrhagic vocal polyps. Patients who received LAVP experienced rapid symptomatic relief with higher subjective effectiveness than phonomicrosurgery, 2 weeks postoperatively. The overall treatment outcomes showed comparable effectiveness between LAVP and phonomicrosurgery.

Correlation Among the Dysphonia Severity Index (DSI), the RBH Voice Perceptual Evaluation, and Minimum Glottal Area in Female Patients With Vocal Fold Nodules

To investigate the clinical significance and correlation of the dysphonia severity index (DSI), the RBH (roughness [R]; breathiness [B]; hoarseness [H]) perceptual voice quality evaluation, and minimum glottal area (MGA) in patients with vocal fold nodules and validate the practicality of the DSI further. The DSI evaluation, the voice RBH perceptual evaluation, and the MGA were performed on 30 female patients with vocal fold nodules (the patient group) and 30 female volunteers with normal voices (the control group). The DSI determination was calculated using the following formula: DSI=0.13×MPT+0.0053×F(0)-High - 0.26×I-Low - 1.18×Jitter(%)+12.4. The RBH evaluation was graded according to four scales. The MGA was measured by KayPENTAX Kips (7105) software. The differences among the DSI, the RBH grade, and MGA of the patients were compared. The median DSI values of the patient group and the control group were -0.81 and 3.79, respectively, and the difference was statistically significant (P<0.01). The median MGA of the patient group and the control group were 355.5 and 121, respectively, and the difference was statistically significant (P<0.01). DSI exhibited moderate negative correlation with R (rP=-0.686, P<0.01), B (rP=-0.609, P<0.01), and H (rP=-0.487, P<0.01). MGA demonstrated moderate positive correlation with R (rP=0.667, P<0.01), B (rP=0.545, P<0.01), and H (rP=0.449, P<0.01), whereas MGA showed strong negative correlation with DSI (rP=-0.888, P<0.01). The application of the DSI as an objective parameter to evaluate dysphonia in female patients with vocal nodules has significant clinical application and good correlation with MGA measurement.

Effects on Vocal Fold Collision and Phonation Threshold Pressure of Resonance Tube Phonation With Tube End in Water

Resonance tube phonation in water (RTPW) or in air is a voice therapy method successfully used for treatment of several voice pathologies. Its effect on the voice has not been thoroughly studied. This investigation analyzes the effects of RTPW on collision and phonation threshold pressures (CTP and PTP), the lowest subglottal pressure needed for vocal fold collision and phonation, respectively. Twelve mezzo-sopranos phonated into a glass tube, the end of which was placed under the water surface in a jar. Subglottal pressure, electroglottography, and audio signals were recorded before and after exercise. Also, the perceptual effects were assessed in a listening test with an expert panel, who also rated the subjects' singing experience. Resonance tube phonation significantly increased CTP and also tended to improve perceived voice quality. The latter effect was mostly greater in singers who did not practice singing daily. In addition, a more pronounced perceptual effect was found in singers rated as being less experienced. Resonance tube phonation significantly raised CTP and tended to improve perceptual ratings of voice quality. The effect on PTP did not reach significance.

SIGnatures: The Quest for Voice Assessment Guidelines

SIG 3 spearheaded the development of a standard method for perceptual evaluation of voice quality—and is on the way to developing clinical protocols for the instruments commonly used in voice assessment.

Reliability and validity of the Korean version of Pediatric Voice Handicap Index: In school age children

ObjectiveThe aim of this study was to assess the reliability and validity of the Pediatric Voice Handicap Index (pVHI) for cross-cultural adaptation of the Korean version with school age children. MethodsThe questionnaire was translated into Korean and was completed by 101 Korean parents who have children with or without disordered voice. The Korean version-pVHI scores were obtained with 60 parents of normal children and 41 parents who have children with voice problems. Content validity was verified by five experienced speech–language pathologists with clinical specialization in voice disorders. Internal consistency was calculated through Cronbach's α coefficient and test–retest reliability of the Korean version-pVHI score was determined using Pearson product-moment correlation coefficients. Mann–Whitney U test was used to compare GRBAS with the Korean version-pVHI scores between normal and dysphonia group. The relationship between the parent-reported the Korean version-pVHI total scores and perceptual ratings of voice quality from experts was investigated using Spearman correlation coefficients. ResultsThe results showed that the Korean version-pVHI provided a high internal consistency (α=0.92) and test–retest reliability of its subscales: total (T) 0.97, functional (F) 0.90, physical (P) 0.95, emotional (E) 0.92. The Korean version-pVHI mean scores in normal group were 1.28 (T), 0.62 (F), 0.35 (P) and 0.32 (E), respectively whereas those of the Korean version-pVHI in children group with dysphonia were 23.13 (T), 8.90 (F), 9.54 (P) and 4.93 (E). Significant differences in the Korean version-pVHI (T, F, P, E) and perceptual evaluation (grade, rough, breathy) between normal and dysphonia group were revealed (P<0.05). Moreover, relatively moderate-to-high correlation between the Korean version-pVHI parameters (T) and perceptual measures (G) was exhibited in children with dysphonia. ConclusionsThe subjective Korean version-pVHI can be applicable and useful supplementary tool for evaluating parents’ perception of their children's voice dysfunction, identifying multifactors on daily life affecting their children's voice and measuring treatment efficacy before and after therapeutic intervention.

Effects of immediate feedback on learning auditory perceptual voice quality evaluation

The study investigated the effect of immediate feedback in training listeners to perceive subtle differences in voice quality, a perceptual skill that is important for speech-language pathologists. Sixty naive listeners were randomly assigned to a feedback group (Group F), a no feedback group (Group NF), and a no training group acting as a control group (Group C). The task was to evaluate the severity of a perceptual voice quality (breathiness) by using a reference-matching paradigm. All participants took part in three rating sessions (pre-training, 2 days after training and 1 week after training). Group F and Group NF participated in a training session immediately after the first rating session, where Group F practiced with immediate feedback given and Group NF practice with no immediate feedback given. The results showed that Group F and Group NF had significant improvement after training, but Group F did not retain the improvement in the third rating session. The use of a reference-matching training paradigm without giving frequent immediate feedback is suggested for auditory-perceptual voice evaluation training. The most effective frequency of immediate feedback is yet to be determined.