Severity Of Voice Disorders Research Articles

A Retrospective Study of Acoustic Measures of Glottal Stop Production to Assess Vocal Function in Unilateral Vocal Fold Paresis/Paralysis Patients.

The aim of this study was to determine (a) diagnostic accuracy of acoustic measures of glottal stop production (GSP; intensity differences, slopes, complete voicing cessation) to distinguish between unilateral vocal fold paresis/paralysis (UVFP) patients and controls; (b) if acoustic measures of GSP significantly correlated with an acoustic measure of voice disorder severity, acoustic voice quality index (AVQI); and (c) if acoustic measures from another type of voicing cessation, voiceless consonant production, also significantly differed between groups. Ninety-seven patients with unilateral paresis/paralysis and 35 controls with normal laryngostroboscopic signs produced two sets of five repeated [i] and four repeated [isi]. Tokens were randomized by type between groups and analyzed blinded using a customized Praat program that computed intensity differences and slopes between vowel maxima and glottal stop minima for inter-[i] tokens and vowel maxima and voiceless consonant minima for intra-[isi] tokens. The number of voicing cessations for inter-[i] tokens was obtained. Onset and offset intensity differences and number of voicing cessations from inter-[i] tokens had the greatest areas under the curve (.854, .856, and .835, respectively). Correlation coefficients were significant (p < .01) between AVQI and all GSP acoustic measures with weak/medium effect sizes. No significant differences were found between controls and participants with UVFP for acoustic measures from intra-[isi]. Acoustic GSP measures demonstrated good diagnostic accuracy and some relationship to severity of voice disorder. No significant differences in acoustic measures for medial voiceless fricative consonants between controls and participants with UVFP suggested that voicing cessation for voiceless fricatives differs from voicing cessation for GSP.

Can Resident Auditory-Perceptual Voice Assessments Predict Medical Urgency of Voice Disorders?

Growing reliance on telemedicine has created new triaging challenges. This study investigated how effectively otolaryngology resident auditory-perceptual voice assessments performed via telemedicine determined the need for urgent in-person clinic visits. Twelve otolaryngology resident physicians (PGY1-PGY5) performed auditory-perceptual assessments on 25 voice samples recorded during initial voice evaluations. Voice samples were balanced in severity and taken in equal numbers from patients with the following diagnoses: benign laryngeal lesions, laryngeal cancer, functional voice disorders, laryngeal edema (associated with LPR), and laryngeal paralysis/paresis. Urgent diagnoses were defined as laryngeal cancer and severe unilateral laryngeal paralysis. For each voice sample, residents were initially blinded to patient medical history. Residents rated severity of voice disorder, predicted patient diagnosis, and determined the urgency of seeing the patient in clinic. Residents then reviewed information from the patient's medical history and again rated urgency of voice disorder. On average, residents identified urgent voice disorders in 56% of cases. After reviewing medical history, this number significantly increased to 77% (P=0.001). Voice severity, smoking history, time since onset, and course of symptoms were considered most influential when determining medical urgency of voice patients. Year in residency program had no effect on rating accuracy. As expected, diagnostic accuracy of auditory-perceptual assessments was low, ranging from 40% for laryngeal paralysis/paresis to 5% for laryngeal edema. Auditory-perceptual voice assessment, combined with medical history, predicted most medically urgent voice disorders. Further work should investigate if task-specific training might improve these results and which medical history items are most critical. Until accuracy of auditory-perceptual assessment of medical urgency is improved, these data underscore the importance of laryngeal examination in identifying medical urgency and etiology of dysphonia.

Multitask and Transfer Learning Approach for Joint Classification and Severity Estimation of Dysphonia.

Despite speech being the primary communication medium, it carries valuable information about a speaker's health, emotions, and identity. Various conditions can affect the vocal organs, leading to speech difficulties. Extensive research has been conducted by voice clinicians and academia in speech analysis. Previous approaches primarily focused on one particular task, such as differentiating between normal and dysphonic speech, classifying different voice disorders, or estimating the severity of voice disorders. This study proposes an approach that combines transfer learning and multitask learning (MTL) to simultaneously perform dysphonia classification and severity estimation. Both tasks use a shared representation; network is learned from these shared features. We employed five computer vision models and changed their architecture to support multitask learning. Additionally, we conducted binary 'healthy vs. dysphonia' and multiclass 'healthy vs. organic and functional dysphonia' classification using multitask learning, with the speaker's sex as an auxiliary task. The proposed method achieved improved performance across all classification metrics compared to single-task learning (STL), which only performs classification or severity estimation. Specifically, the model achieved F1 scores of 93% and 90% in MTL and STL, respectively. Moreover, we observed considerable improvements in both classification tasks by evaluating beta values associated with the weight assigned to the sex-predicting auxiliary task. MTL achieved an accuracy of 77% compared to the STL score of 73.2%. However, the performance of severity estimation in MTL was comparable to STL. Our goal is to improve how voice pathologists and clinicians understand patients' conditions, make it easier to track their progress, and enhance the monitoring of vocal quality and treatment procedures. Clinical and Translational Impact Statement: By integrating both classification and severity estimation of dysphonia using multitask learning, we aim to enable clinicians to gain a better understanding of the patient's situation, effectively monitor their progress and voice quality.

Prevalence of Voice Disorders among University Teachers

Background: Voice disorders pose a significant occupational hazard for individuals in voice-demanding professions, notably university professors. The complexity and frequency of these disorders highlight the need for a deeper understanding of their prevalence, severity, and the impact on affected individuals. Objective: This study aimed to investigate the prevalence and severity of voice disorders among university professors, examining the differences in occurrence between genders and identifying potential risk factors contributing to these conditions. Methods: Employing an observational cross-sectional study design, data were collected from a sample of 390 university professors from various institutions. Participants were assessed for voice disorders using a comprehensive voice handicap questionnaire. The severity of voice disorders was categorized into mild, moderate, and severe based on self-reported symptoms. Statistical analysis was conducted using SPSS version 26 to analyze demographic information, with percentages calculated for qualitative data and mean and standard deviation for quantitative data. Results: The study found that 57.7% of participants experienced mild voice disorders, 22.8% moderate, and 19.5% severe, indicating a significant prevalence of voice issues among university professors. Gender analysis revealed that males exhibited a higher prevalence (58.5%) compared to females (41.5%), yet females reported greater severity in their conditions. Additionally, age-related differences suggested younger professors were more susceptible to voice disorders. Conclusion: Voice disorders are notably prevalent among university professors, with significant variations in severity observed between genders. These findings underscore the importance of implementing preventive measures and vocal hygiene programs tailored to the needs of those in voice-intensive occupations. Addressing these issues is vital for maintaining vocal health and ensuring the longevity of professionals' careers in education.

Voice Handicap Index: Cut-Off Points for Screening European Portuguese With Voice Disorders

To determine cut-off values of the Voice Handicap Index (VHI) and the shortened version (VHI-10) for European Portuguese (EP) with voice disorders. In addition, to analyze the discriminatory power of individual items of the VHI-10 and the ability to detect differences in various Ear Nose and Throat (ENT) diagnoses. Cross-sectional cohort study. All participants completed the EP VHI and a 4-point self-assessment of voice disorder severity. The case group (subjects with voice disorders) underwent assessment through strobovideolaryngoscopy examinations by ENT surgeons and perceptual analyses by speech-language pathologists (SLPs). In contrast, the control group was evaluated solely by SLPs. Data were analyzed using a receiver-operating characteristic curve to determine the accuracy and cut-off values of the VHI and VHI-10. The study involved a sample of 350 adults (171 cases and 179 controls), predominantly women aged 18-88years. The area under curve (AUC) for VHI and VHI-10 was 0.997 [95% confidence interval (CI): 0.992-1] and 0.998 [95% CI: 0.995-0.999], respectively. Optimal cut-off values were identified as 13.5 for VHI (0.994 sensitivity and 0.989 specificity) and 5.5 for VHI-10 (0.977 sensitivity and 0.955 specificity). Each individual item within the VHI-10 significantly contributed to the overall assessment, exhibiting varying discriminatory power ranging from excellent (AUC=0.937) to poor (AUC=0.637). Significant differences were found in the case group between neurogenic disorders and healthy larynx (P=0.014), structural and physiologic minor laryngeal abnormalities (P=0.006), and inflammatory disorders (P=0.043). The VHI and the VHI-10 exhibited accurate screening properties for predicting EP speakers with voice disorders.

Commentary on “Effects of Cough Suppression Therapy on Voice Disorder Severity”

Cough Suppression Therapy (CST) is a unique type of voice therapy provided by a Speech Language Pathologist (SLP) that addresses behavioral modifications to manage chronic refractory cough.

Application of Nursing Intervention Based on the Information-motivation-behavioral Model in Rehabilitation after Vocal Cord Polypectomy

Background: Vocal cord polyps are common benign lesions that cause voice disorders, particularly hoarseness, which can interfere with daily communication. Objectives: The present study aimed to determine the effect of applying a nursing intervention based on the information-motivation-behavioral (IMB) model on rehabilitation after vocal cord polypectomy. Methods: A total of 76 patients who underwent vocal cord polyp resection in Wuhu Second People's Hospital between January 2019 and September 2021 were selected by convenience sampling as the study participants. A random number table was used to assign the patients to two groups, an intervention group and a control group (n=38 in each group). Patients in the control group were given routine postoperative nursing, whereas those in the intervention group received an IMB-based nursing intervention based on that of the control group. The data collected regarding self-care ability, vocal cord recovery, and voice disorder severity of the two groups after surgery were compared in January and February. Results: The Exercise of Self-Care Agency scale scores of the intervention group were higher than those of the control group both one and two months after surgery, and the difference was statistically significant (97.1±26.1 vs. 84.6±19.8, 103.3±28.4 vs. 85.6±20.0, P&lt; 0.05), indicating the superior self-care ability of the intervention group. The Voice Handicap Index scores of the intervention group were lower than those of the control group both one and two months after the surgery, and the difference was statistically significant (35.8±9.2 vs. 39.8±13.9, 24.6±6.2 vs. 29.7±7.3, P&lt;0.05), indicating that voice disorder severity was lower in the intervention group than in the control group. Moreover, the effective rates (recovery and improvement) of the intervention group were higher than those of the control group one and two months after the surgery. Conclusion: As evidenced by the obtained results, nursing intervention based on the IMB model for patients who undergo vocal cord polyp resection can effectively improve self-care ability, reduce the severity of voice disorders, and promote the recovery of vocal cords.

Epidemiology Of Voice Disorders Among Government School Teachers - An Analytical Cross-Sectional Study from Kancheepuram District

Background: Voice disorders cause undesirable effects on school teachers such as reducing their quality of life, decrease in work performance affecting the quality of education, job absenteeism, and reduced social activities as well. Methodology: Voice disorder among teachers was assessed through the “Voice handicap Index”, which was developed by Jacobson et al in 1997 to self-assess the severity of voice disorder in dysphonia patients Results: The overall prevalence of voice disorder among government school teachers was found to be 46.5% with a 95% confidence interval from 41.5% to 51.5%. Using Backward Wald, the binary logistic regression analysis showed that female teachers (AOR 1.6, p&lt;0.01*), teaching experience less than 10 years (AOR 2.4, p&lt;0.01*), and teaching hours more than 21 hours per week (AOR 6.7, p&lt;0.01*) had a significant association with voice disorders. Conclusion: The prevalence of voice disorder was found to be high since teachers are professional voice users. The study also recommends that teachers must receive the required health education on the ergonomic risk factors that they will come into contact with in their daily lives as part of their jobs.

Multidimensional Voice Assessment After Management of Early Laryngeal Cancer: A Comparative Study.

Laryngeal Squamous Cell Carcinoma is one of the most common head and neck cancers, and patients experience dysphonia after treatment with transoral laser microsurgery (TLM) or radiotherapy (RT). This study aimed to investigate the multidimensional assessment of voice, based on objective and subjective evaluation. In this cross-sectional study, a group of 120 patients (mean = 57.59years, SD = 4.87), including men (n = 116) and women (n = 4) with early laryngeal carcinoma, were divided into two groups; Patients who had undergone TLM (n = 60) or RT (n = 60). The multidimensional assessment of voice was conducted using the acoustic analysis, the dysphonia severity index (DSI), the Persian versions of Consensus Auditory Perceptual Evaluation of Voice, and the voice handicap index (VHI). Results revealed that objective voice assessment only shows differences (P < 0.001) in the DSI between TLM and RT groups, despite there being no significant differences (P = 0.196) in overall severity of voice disorder in comparison between them. Also, there is a significant difference (P < 0.05) based on the Emotional subscale of VHI, between irradiated and TLM-treated patients. This finding showed that TLM-treated patients with early laryngeal carcinoma had severe voice disorder compared to irradiated patients. In addition, radiotherapy has a greater impact on the emotions of patients with early glottic cancer.

Validity, internal consistency, and test-retest reliability of the Montenegrin 10-item Voice Handicap Index.

The purpose of the this cross-sectional study was to assess clinical validity, internal consistency, and test-retest reliability of the adapted Montenegrin translation of the Voice Handicap Index 10 (VHI-10). It included 50 patients with voice disorders, divided into three subgroups according disease aetiology: structural, neurological, and functional and a control group of 50 vocally healthy participants. Mean patient VHI-10 score of 21.1±7.6 was significantly higher than the 2.3±2.5 score of controls (p<0.001). Each of the three patient subgroups also scored significantly higher than control (p<0.001). Spearman’s rank correlation coefficient of 0.90 (p<0.001) indicated a very strong correlation between the Montenegrin VHI-10 score and self-reported perception of the severity of voice disorder. Excellent internal consistency was found in the patient group, with a Cronbach’s alpha of 0.94. Test-retest reliability was also excellent, with intra class correlation coefficient of 0.98. The translated Montenegrin version of VHI-10 is a valid, reliable, and clinically useful tool for self-assessment of the severity of voice disorders in individuals with voice problems in daily practice and in research projects.

Comparison of teachers' voice disorders before and during COVID-19 pandemic.

&lt;b&gt; Aim:&lt;/b&gt; The aim of the study was to analyze the impact of the COVID-19 pandemic and the related change of the teaching mode from stationary to distance learning on the severity of voice-related ailments among teachers. &lt;/br&gt;&lt;/br&gt; &lt;b&gt; Materials and methods:&lt;/b&gt; A questionnaire survey of teachers was conducted to assess voice disorders during stationary and remote work using the Vocal Tract Discomfort (VTDs) scale and Numeric Rating Scale (NRS), and the respondents' subjective feelings were assessed. Demographic and environmental factors associated with voice work were examined. Data on sickness absence, which were obtained from the "Health Needs Maps 2020" Ministry of Health's, were also analyzed. Responses were subjected to statistical analysis. A P-value level below 0.05 was considered statistically significant. &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Results:&lt;/b&gt; 128 teachers participated in the survey. The overall assessment of voice disorders using VTDs and NRS scales showed no statistically significant differences for complaints between stationary and remote work. Detailed analysis revealed more se-vere voice disorders in teachers working more than 6 months remotely (P = 0.049) and having more than 20 lessons per week (P = 0.012). Subjective assessment confirmed a significantly lower percentage of teachers reporting voice disorders when wor-king remotely compared to stationary (P = 0.043). This resulted in less sickness absence and a 40% decrease in sick leave related to voice disorders in 2020 compared to 2019. &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Conclusions:&lt;/b&gt; During the remote learning period of the COVID-19 pandemic, teachers reported lower severity of voice disor-ders and this influenced the reduction of sickness absences. There were no statistically significant differences in voice complaints as assessed by VTDs and NRS scales for both teaching modes. Several factors affecting the severity of vocal tract disorders were identified - the number of class hours per week (&gt;20) for stationary teaching and a long period of remote teaching (&gt;6 months).

Effects of Cough Suppression Therapy on Voice Disorder Severity.

To determine changes in voice severity when treating chronic cough refractory to medical treatment with cough suppression therapy (CST) in patients with chronic cough and voice complaints. Chronic cough has been reported to be refractory to medical treatment and frequently co-occurs with voice disorders. The possible effects of CST on self-assessed changes in chronic cough and voice disorders have not been demonstrated. Retrospective analysis of the effects of cough suppression therapy (CST) on self-assessed changes in chronic cough and voice disorder severity in patients with both chronic cough and voice disorders. Forty-three adult patients with the primary complaint of chronic refractory cough underwent pre- and post-treatment diagnostic examinations, completed pre- and post-treatment Voice Handicap Index-10 (VHI-10) and Cough Severity Index assessments, and were treated by a licensed speech-language pathologist using CST. Twenty-seven subjects were assigned to the cough (C) group and 16 to the cough-voice (CV) group based on the severity of their VHI-10 scores. Post-test analysis showed significant improvement in cough severity for both groups and significant improvement in voice severity for the CV group. The VHI-10 scores for the C group did not change significantly. The median number of treatment sessions was 3, with a range of 1-13 sessions. Correlation between changes in severity and number of treatment sessions was not found to be significant at the tested level. CST represents a unifying approach for treatment of patients with CRC and comorbid voice disorders. CST offered cross-over effects to the voice when subjects were treated for their primary complaint of chronic cough. This treatment of the primary complaint improves function in systems that share a common pathway. 4 Laryngoscope, 131:2747-2751, 2021.

Using remotely collected voice recordings for clinical voice evaluation: A feasibility study

The COVID-19 pandemic underscored the importance of telepractice in the care of voice disorders. Acoustic analyses are routinely conducted for determining the presence and severity of voice disorders. In the in-person voice evaluation, the recording environment is carefully controlled as the recording's quality can affect the acoustic analyses' output. Telepractice environment does not allow such control, challenging this aspect of voice evaluation. In order to capture the nature of this challenge, this study examined the feasibility of using remotely collected voice recordings for the acoustic evaluation of disordered voice. Thirteen students in Vocal Performance and Theater studies were trained to perform individuals with voice disorders as standardized patients (SPs) and underwent a remote voice evaluation. Recordings of sustained vowels and sentences were collected via Zoom and the SP's personal computers. The fundamental frequency, cepstral peak prominence, and harmonic-to-noise ratio were calculated from these recordings. A listening experiment was also conducted to examine the perceptual similarity between the Zoom and computer recordings. The preliminary data analyses indicated that the mode of voice recording significantly affects the listener's perception and acoustic analyses of dysphonic voice. Clinical implications and possible strategies for future studies will be discussed.

Accuracy of Acoustic Voice Quality Index and Its Isolated Acoustic Measures to Discriminate the Severity of Voice Disorders

To evaluate the Acoustic Voice Quality Index (AVQI) and its isolated acoustic measures accuracy in discriminating voices with different degrees of deviation. Two hundred and fifty-eight voice samples (160 dysphonic; 98 vocally healthy). Information regarding acoustic analysis and overall degree of deviation (G) were considered. The acoustic analysis consisted of the AVQI total score and its isolated acoustic measures: smoothed cepstral peak prominence (CPPs); harmonic-to-noise ratio (HNR); shimmer local and dB (Shim, ShdB); the general slope of the spectrum (Slope) and tilt of the regression line through the spectrum (Tilt). The auditory-perceptual judgment was the median G score of five voice specialists (Cohen's=0.605-0.773; Fleiss=0.370). Quadratic discriminant analysis and accuracy, sensitivity, and specificity of performance measures were used to investigate the discriminatory power of these measures. AVQI presented acceptable accuracy to differentiate voices with no vocal deviation and with vocal deviation (73.9%) and among the degrees of deviation (mild vs. moderate=70.49%; mild vs. moderate=71.39%; moderate vs. severe=87.5%). No isolated acoustic measurement was consistent with differentiating voice quality among all degrees of deviation. A combination of five acoustic measures (CPPs, HNR, ShdB, Slope, Tilt) had the highest accuracy to differentiate between healthy and deviated voice (75.55%). Shimmer was more accurate to discriminate between voices with mild, moderate, and severe deviation; almost all isolated acoustic measurements were accurate to discriminate voices with moderate and severe deviation. The combination of acoustic measures presented higher accuracy (mild vs. moderate=70.21%-74.29%; mild vs. moderate=71.53%-76.11%; moderate vs. severe=86%-95.50%). AVQI is an accepted tool to discriminate among different degrees of vocal deviation, and more accurate between voices with moderate and severe deviations. Isolated acoustic measures perform better when discriminating voices with a higher degree of deviation. A combination of acoustic parameters, with the same weight, is more accurate to discriminate different degrees of deviation, however, not consistent.

Polish version of the pediatric Voice Handicap Index (pVHI)

IntroductionThe modern standard of voice diagnostics in both the adult and pediatric populations is based on perceptual, acoustic and videolaryngoscopic assessment, as well as self-assessment of voice quality. Currently, only two tools for assessing the voice in the pediatric population were translated into Polish: pVHI and its abbreviated version - cVHI (Children Voice Handicap Index). Thanks to the use of pVHI, the therapist and the patient, as well as his family and relatives, become aware of what functional zones are disturbed as a result of voice problems. AimThe aim of the study was to analyze various methods of assessing children's voice, including the pVHI voice disability questionnaire in children with various voice disorders. In addition, the authors wanted to develop a classification of the degree of disability of children's voice expressed by the sum of points obtained in pVHI. Material and methodThe study included a group of 89 children aged 5-12. Each child underwent a standard otolaryngological and phoniatric examination procedure with hearing assessment and fiberoscopic laryngeal evaluation. The voice of the dysphonic children was assessed with a spectrogram and the GRBAS scale. The children's guardians completed the Pediatric Voice Handicap Index (pVHI). ResultsPolish children without voice disorders obtained an average of 1.9 points as a total result of the pVHI questionnaire. The results of the questionnaire obtained from children with voice disorders were on average 24.7 (SD 13.9). Total and individual domain scores were significantly higher in children with dysphonia than in asymptomatic children. Children with voice disorders were rated an average of 1.95 (SD 0.6) degree of hoarseness in Yanagihara's scale, and obtained an average overall score of 4.8 on the GRBAS scale (SD 2). A common upward trend in all types of evaluation is evident, along with an increase in the handicap expressed in pVHI score. Statistical analysis showed significant dependence between the overall pVHI score and other voice rating indicators. The result correlated to a moderate degree with the sum of points obtained from GRBAS and the severity of hoarseness assessed subjectively (G) and objectively according to Yanagihara's scale. In addition, weak correlations of the functional part of the questionnaire with the presence of learning problems, and the emotional part with the presence of problems with socialization were noticed. Analyzing the results of the questionnaire depending on the GRBAS results and the Yanagihara scale, a better fit of the exponential trend line than the linear one was observed. The point of inflection of the exponential curve, and thus a significant deterioration in voice assessment indicators, was observed in children who obtained over 32 points, which is 33% of the maximum value that can be obtained from the questionnaire. ConclusionsA new voice assessment tool for the pediatric population has been developed that complements the diagnostic facilities of the otolaryngologist, phoniatrician and speech therapist. Adaptation of the Polish version of the Voice Handicap Index (pVHI) allows the introduction of a new diagnostic indicator into medical and speech therapy practice. The pVHI questionnaire result differentiates children with voice and speech disorders from healthy children. The analysis of children's voice using various methods allows the clinician to further characterize the disturbance of voice quality. It is possible to assess the scale of the severity and type of problem, as well as the spheres of life it concerns most. There is a correlation between the severity of voice disorders and the severity of voice disability expressed in the pVHI question.

Adaptation and validation of the Persian version of pediatric Voice Handicap Index (pVHI)

Background and objectivesThis study aimed to assess the reliability and validity of the Persian version of the Pediatric Voice Handicap Index (pVHI). Materials and methodsThe questionnaire was translated into Persian and then administrated to the parents of 45 dysphonic children and parents of 135 normal children. The content validity of the questionnaire was confirmed by eight speech-language pathologists. Internal consistency and test-retest reliability were measured via Cronbach's alpha and intra-class correlation coefficient, respectively. Independent-samples t-test was used to evaluate the discriminative and clinical validity of Persian pVHI. ResultsCronbach's coefficient values were excellent for the total score (α = 0.94) and physical subcomponent (α = 0.91). Moreover, these corresponding values were satisfactory for functional (α = 0.82) and emotional (α = 0.79) subcomponents. Test-retest reliability for the total score was high in both dysphonic and control groups (intra-class correlation coefficient> 0.92). There were significant differences between the control and dysphonic groups in terms of the total score and all subcomponents scores of Persian pVHI. However, no significant difference was observed in the mean total score of the Persian pVHI between the control and dysphonic group regarding gender (P < 0.001). DiscussionPersian version of pVHI is a valid and reliable tool to evaluate the severity of voice disorder and its negative effects on the daily life of Persian children with voice disorder from the Parents' viewpoint.

The Association between Paradoxical Vocal Fold Motion and Dysphonia in Adolescents

Objective: Associations between dysphonia and paradoxical vocal fold motion (PVFM) have been previously reported in adults, but it is unclear whether similar associations exist for adolescents. The goals of this study were to identify the prevalence and severity of voice disorders in adolescent patients with PVFM, identify differences between those with and without clinician-identified dysphonia, and investigate what factors were associated with voice handicap in this population. Methods: A retrospective review of eligible adolescent patients diagnosed with PVFM over a 1-year period at a single institution was undertaken. Data collected from the medical record included demographic background, medical history and workup, patient- and family-reported symptoms, and findings from the laryngeal examination. The presence or absence of clinician-diagnosed dysphonia was used to subdivide the sample for analysis. Results: Forty-eight patients with PVFM were included. The sample was primarily female (73%) with a median age of 15 years. Few patients had voice complaints (5%), but clinician-diagnosed dysphonia was common (52%) and ranged from mild to moderate. Vocal hyperfunction was frequently observed (55%), but anatomic abnormalities associated with dysphonia were rare (6%). Adolescents with dysphonia were significantly older, more likely to have vocal hyperfunction on laryngoscopy, and more likely to return for therapy than those without dysphonia. No notable differences existed in the number of behavioral therapy sessions or in the likelihood of completing treatment between the two groups. The majority of participants (79%) had at least one “confounding factor” (i.e., were currently taking a medication for asthma, allergies, or reflux, or had a laryngeal abnormality) but this did not differ significantly between those with and without dysphonia. A minority of individuals (28%) had abnormal scores on the Voice Handicap Index (VHI). Age was positively correlated with dysphonia severity but no other significant associations were observed. Conclusion: Although voice complaints are rare, dysphonia among adolescents with PVFM is common and can occur in the absence of laryngeal abnormalities and medical comorbidities, typically as a result of vocal hyperfunction. Dysphonia does not appear to be a barrier to PVFM treatment and may be a useful target in therapy.

Acoustic Psychometric Severity Index of Dysphonia (APSID): Development and Clinical Application

The purpose of this study was to explore the predictability of the Korean version of the Voice Activity and Participation Profile (K-VAPP) scores and acoustic measures for perceived severity of voice disorders. Furthermore, usefulness of the index derived from the multivariate formula as a screening tool for voice disorders was explored and compared with that of the Cepstral Spectral Index of Dysphonia (CSID). A total of 150 patients with various voice disorders (42 males and 108 females, age=45.15 ± 15.15 years) and matched 50 normal controls (14 males and 36 females, age=44.78 ± 13.70 years), participated in the study. Correlates of perceived overall severity were explored by a stepwise regression analysis with regards to demographic information (age, gender, and professional voice use), jitter, shimmer, and noise-to-harmonic ratio of vowel samples, cepstral peak prominence (CPP), L/H spectral ratio, and their standard deviations of sentence and vowel samples, and psychometric measures of the K-VAPP. Using the ROC curve analysis, the area under curve (AUC) of the novel index derived from the regression equation and the CSID were compared and the cut-off score of the index was obtained. A significant portion (adjusted R square=79.0%) of the overall severity perceived by clinicians was predicted by five parameters: CPP of the sentence and vowel production, the self-perceived severity subscale score of the K-VAPP, σCPP of the vowel production, and gender. The AUC of the novel index was 0.935 (95% confidence interval 0.891-0.965) and significantly higher than that of the CSID of vowel samples (AUC=0.832). The cutoff score with the highest Youden J Index (0.7612) was >22.257617 (sensitivity=82.12%, specificity=94.00%). The current data showed the possibility that a novel index reflecting both acoustic and psychometric correlates of auditory-perceptual estimates for dysphonia severity could be suggested and possibly named as the "Acoustic Psychometric Severity Index of Dysphonia (APSID)." Further studies pertaining to the follow-up of various voice disorders are needed to extend its clinical usefulness.

Validation of Acoustic Voice Quality Index Version 3.01 and Acoustic Breathiness Index in Korean Population

This study aimed to verify the Acoustic Voice Quality Index (AVQI) version 3.01 and the Acoustic Breathiness Index (ABI) as tools for acoustic analyses in the Korean language. Concatenated voice samples of sustained vowels (SV) and continuous speech (CS) were collected from 151 subjects with dysphonia and 71 vocally healthy subjects. The overall voice disorder severity (grade [G] and overall severity [OS]) and breathiness severity (B) were subjected to an auditory-perceptual rating by three raters. First, we equalized the proportions of SV and CS with respect to the time lengths of the voice samples to improve the ecological validity. We then validated the AVQI and ABI in the Korean language, using our most recent dataset of 1,667 voice samples. Second, we compared the results of the acoustic analyses between the vocally healthy controls and the dysphonia groups. Third, we confirmed the concurrent validity and diagnostic accuracy using the Spearman rank-order correlation coefficient (rs) and various statistical methods (receiver operating characteristic curve, pairwise comparison, and likelihood ratio [LR] analyses). We observed strong inter-rater reliability for G, B, and OS. Moreover, we identified 26 standardized syllables in the CS samples (3 second voiced segments), which allowed the equalization of both voice tasks. A comparison of the two voice groups revealed statistically significant differences in the AVQI, ABI, G, B, and OS (all P < 0.01). Moreover, we identified strong correlations of the AVQI with G (rs > 0.88, P < 0.01) and OS (rs > 0.84, P < 0.01) and of ABI with B (rs > 0.87, P < 0.01). Finally, we confirmed cutoffs of 3.154 (sensitivity: 90%, specificity: 89%, LR+: 8.45, and LR-: 0.12) and 3.685 (sensitivity: 88%, specificity: 86%, LR+: 6.47, and LR-: 0.14) as optimal predictive powers for AVQI and ABI, respectively. As per our results, in a sample of Korean speakers, the AVQI and ABI exhibited strong concurrent validity for the quantification of dysphonia severity with respect to OS and B. We consider that analyses based on the AVQI and ABI will enable the discrimination and assessment of dysphonia in clinical practice.

A Comparison of Quality of Life in Adults With Voice Disorders Before and After Voice Therapy

Background: Previous studies have documented the effectiveness of voice therapy in terms of voice quality outcomes rather than quality of life outcomes.&#x0D; Objective: To compare the quality of life among patients with voice disorders, before and after voice therapy.&#x0D; Methods: Thirty-six patients with voice disorders who visited the Speech Clinic at Ramathibodi Hospital from March 2013 to January 2015 were enrolled. Thirty minutes per session within 10 weeks period of voice therapy program were used. The voice therapy approaches included direct and indirect therapy. The outcomes of this study were measured using Dr. Speech software version 5 for acoustic analysis and the Voice Handicap Index in Thai version for quality of life. Data was analyzed by descriptive and inferential statistics (Paired t test).&#x0D; Results: The total participants were 36 patients with a mean age of 51.31 years. They were divided to 4 groups according to the causes of voice disorders that were 18 patients for structural cause, 8 patients for functional cause, 6 patients for neurological cause, and 4 patients for inflammatory cause. The results for both voice quality and quality of life after voice therapy improved and showed statistically significant differences (P &lt; .05). The patients with all causes of voice disorders were statistically significant differences in total the Voice Handicap Index scores (P &lt; .05). Moreover the structural causes group exhibited statistically significant differences in all subscales (P &lt; .05) but the others causes groups were not statistically significant differences in emotional subscale for functional causes, physical subscale for neurological causes, and functional subscale for inflammatory cause (P &gt; .05)&#x0D; Conclusions: Voice therapy might be an effective treatment to decrease the severity of voice disorders in role of voice quality and quality of life, especially voice disorders from structural causes.