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Curtis JA, Borders JC, Dakin AE, Troche MS. Auditory-Perceptual Assessments of Cough: Characterizing Rater Reliability and the Effects of a Standardized Training Protocol. Folia Phoniatr Logop 2023; 76:77-90. [PMID: 37544291 DOI: 10.1159/000533372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/24/2023] [Indexed: 08/08/2023] Open
Abstract
INTRODUCTION Auditory-perceptual assessments of cough are commonly used by speech-language pathologists working with people with swallowing disorders with emerging evidence beginning to demonstrate their validity; however, their reliability among novice clinicians is unknown. Therefore, the primary aim of this study was to characterize the reliability of auditory-perceptual assessments of cough among a group of novice clinicians. As a secondary aim, we assessed the effects of a standardized training protocol on the reliability of auditory-perceptual assessments of cough. METHODS Twelve novice clinicians blindly rated ten auditory-perceptual cough descriptors for 120 cough audio clips. Standardized training was then completed by the group of clinicians. The same cough audio clips were then re-randomized and blindly rated. Reliability was analyzed pre- and post-training within each clinician (intra-rater), between each unique pair of raters (dyad-level inter-rater), and for the entire group of raters (group-level inter-rater) using intraclass correlation coefficients and Cohen's Kappa. RESULTS Pre-training reliability was greatest for measures of strength, effectiveness, and normality and lowest when judging the type of expiratory maneuver (cough, throat clear, huff, other). The measures that improved the most with training were ratings of perceived crispness, amount of voicing, and type of expiratory maneuver. Intra-rater reliability coefficients ranged from 0.580 to 0.903 pre-training and 0.756-0.904 post-training. Dyad-level inter-rater reliability coefficients ranged from 0.295 to 0.745 pre-training and 0.450-0.804 post-training. Group-level inter-rater reliability coefficients ranged from 0.454 to 0.919 pre-training and 0.558-0.948 post-training. CONCLUSION Reliability of auditory-perceptual assessments varied across perceptual cough descriptors, but all appeared within the range of what has been historically reported for auditory-perceptual assessments of voice and visual-perceptual assessments of swallowing and cough airflow. Reliability improved for most cough descriptors following 30-60 min of standardized training. Future research is needed to examine the validity of auditory-perceptual assessments of cough by assessing the relationship between perceptual cough descriptors and instrumental measures of cough effectiveness to better understand the role of perceptual assessments in clinical practice.
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Affiliation(s)
- James A Curtis
- Department of Otolaryngology-Head and Neck Surgery, Aerodigestive Innovations Research Lab (AIR), Weill Cornell Medical College, New York, New York, USA
- Department of Biobehavioral Sciences, Laboratory for the Study of Upper Airway Dysfunction, Teachers College, Columbia University, New York, New York, USA
| | - James C Borders
- Department of Biobehavioral Sciences, Laboratory for the Study of Upper Airway Dysfunction, Teachers College, Columbia University, New York, New York, USA
| | - Avery E Dakin
- Department of Biobehavioral Sciences, Laboratory for the Study of Upper Airway Dysfunction, Teachers College, Columbia University, New York, New York, USA
| | - Michelle S Troche
- Department of Biobehavioral Sciences, Laboratory for the Study of Upper Airway Dysfunction, Teachers College, Columbia University, New York, New York, USA
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Hosokawa K, Iwahashi T, Iwahashi M, Iwaki S, Kato C, Yoshida M, Yoshida D, Kitayama I, Umatani M, Matsushiro N, Ogawa M, Inohara H. The Significant Influence of Hoarseness Levels in Connected Speech on the Voice-Related Disability Evaluated Using Voice Handicap Index-10. J Voice 2023; 37:290.e7-290.e16. [PMID: 33376022 DOI: 10.1016/j.jvoice.2020.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 11/17/2020] [Accepted: 11/19/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES This retrospective study examines the influence of voice quality in connected speech (CS) and sustained vowels (SV) on the voice-related disability in patients' daily living documented by Voice Handicap Index-10 (VHI-10). METHODS A total of 500 voice recordings of CS and SV samples from 338 patients with voice disturbances were included, along with the patients' age, diagnoses, maximum phonation time, and VHI-10. Dataset-1 comprised of 338 untreated patients, whereas Dataset-2 included 162 patients before and after phonosurgeries. As a preliminary study, the concurrent and diagnostic validities based on auditory-perceptual judgments were examined for cepstral peak prominence (CPP) and CPP smoothed (CPPS) for CS and SV tasks. Next, simple correlations and multivariate regression analyses (MRA) were performed to identify which of the acoustic measures for the CS or SV tasks significantly influenced the total score or improvement of VHI-10. RESULTS The preliminary study confirmed high correlations with hoarseness levels as well as the excellent diagnostic accuracy of CPP and CPPS for both CS and SV tasks. In Dataset-1, the simple correlations and MRA results showed that cepstral measures in both tasks demonstrated moderate correlations with, and significant contribution to the total score of VHI-10, respectively. However, in Dataset-2, the changes of cepstral measures, as well as the median pitch after phonosurgeries in the CS tasks only, showed significant contributions to the improvement of VHI-10. CONCLUSION The study demonstrated that the hoarseness levels in both the CS and SV tasks equivalently influenced the VHI-10 scores, and that the post-surgical change of voice quality only in the CS tasks influenced the improvement of voice-related disability in daily living.
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Affiliation(s)
- Kiyohito Hosokawa
- Department of Otorhinolaryngology and Head & Neck Surgery, Osaka University Graduate School of Medicine, Suita-city, Japan; Department of Otorhinolaryngology, Japan Community Health care Organization (JCHO) Osaka Hospital, Osaka-city, Osaka, Japan; Department of Otorhinolaryngology, Osaka Police Hospital, Osaka-city, Osaka, Japan.
| | - Toshihiko Iwahashi
- Department of Otorhinolaryngology and Head & Neck Surgery, Osaka University Graduate School of Medicine, Suita-city, Japan
| | - Mio Iwahashi
- Nimura ENT Voice Clinic, Osaka-city, Osaka, Japan
| | - Shinobu Iwaki
- Department of Otorhinolaryngology and Head & Neck Surgery, Kobe University Graduate School of Medicine, Kobe-city, Hyogo, Japan
| | - Chieri Kato
- Department of Otorhinolaryngology and Head & Neck Surgery, Osaka University Graduate School of Medicine, Suita-city, Japan
| | - Misao Yoshida
- Department of Rehabilitation, Nishinomiya Kaisei Hospital, Nishinomiya-city, Hyogo, Japan
| | - Daichi Yoshida
- Department of Otorhinolaryngology, Japan Community Health care Organization (JCHO) Osaka Hospital, Osaka-city, Osaka, Japan
| | - Itsuki Kitayama
- Department of Otorhinolaryngology and Head & Neck Surgery, Osaka University Graduate School of Medicine, Suita-city, Japan; Department of Otorhinolaryngology, Japan Community Health care Organization (JCHO) Osaka Hospital, Osaka-city, Osaka, Japan
| | - Masanori Umatani
- Department of Otorhinolaryngology and Head & Neck Surgery, Osaka University Graduate School of Medicine, Suita-city, Japan
| | - Naoki Matsushiro
- Department of Otorhinolaryngology, Osaka Police Hospital, Osaka-city, Osaka, Japan
| | - Makoto Ogawa
- Department of Otorhinolaryngology and Head & Neck Surgery, Osaka University Graduate School of Medicine, Suita-city, Japan; Department of Otorhinolaryngology, Japan Community Health care Organization (JCHO) Osaka Hospital, Osaka-city, Osaka, Japan
| | - Hidenori Inohara
- Department of Otorhinolaryngology and Head & Neck Surgery, Osaka University Graduate School of Medicine, Suita-city, Japan
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Zhao EE, Nguyen SA, Salvador CD, O'Rourke AK. A Meta-Analysis of the Association Between the Voice Handicap Index and Objective Voice Analysis. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:3461-3471. [PMID: 32955998 DOI: 10.1044/2020_jslhr-20-00209] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose Dysphonia can be evaluated by both patient-reported quality of life instruments and objective acoustic and aerodynamic analyses. However, less is known about the association between the two metrics. The goal of this study was to perform a meta-analysis of the correlation of the Voice Handicap Index (VHI-30) with the following objective parameters: fundamental frequency, jitter, shimmer, harmonics to noise ratio, noise to harmonic ratio, maximum phonation time, and the Dysphonia Severity Index. Method A literature search was performed in the PubMed, Scopus, and Cumulative Index of Nursing and Allied Health Literature databases. Inclusion criteria were subjects age 18 years and older with voice complaints and assessed by both VHI-30 and objective voice analysis. Results A literature search resulted in 1,297 unique articles, of which 310 underwent full-text review and 17 studies were included in quantitative analysis. Significant pooled correlation was observed for VHI-30 total with jitter (.301 [.177; .416]), shimmer (.255 [.162; .344]), noise to harmonic ratio (.200 [.111; .285]), maximum phonation time (-.227 [-.352; -.094]), and Dysphonia Severity Index (-.254[-.455; -.0286]). Significant correlations were observed in 4/7 objective parameters with the Physical subscale, 3/7 with the Functional subscale, and 2/7 with the Emotional subscale. All significant correlations were negligible (0-.3) or low (.3-.5). Conclusions Results from meta-analysis showed that correlations between objective voice parameters and the VHI-30 were negligible or low. Further study is needed to determine if correlations vary by patient demographics or specific pathology.
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Affiliation(s)
- Elise E Zhao
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Craig D Salvador
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Ashli K O'Rourke
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
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Tsuji DH, Kinchoku VM, Imamura R, Hachiya A, Yamasaki R, Marinho GR, Sennes LU. Bipedicled Vocal Fold Mucosal Flap Use in Phonomicrosurgery: Case Series. J Voice 2020; 35:793-799. [PMID: 32327357 DOI: 10.1016/j.jvoice.2020.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 12/21/2019] [Accepted: 01/09/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The objective of this study was to present a novel surgical technique involving the use of a "bipedicled vocal fold mucosal flap" to repair a mucosal defect and to evaluate the outcomes of patients in whom it was used. MATERIAL AND METHODS This was a retrospective study of 6 clinical cases. All patients underwent surgery between November 2000 and July 2018, and all procedures were performed by the same surgeon. For the auditory-perceptual assessment, the Grade-Roughness-Breathiness-Asthenia-Strain hoarseness scale was used. We based the stroboscopic evaluation on the European Laryngological Society protocol, analyzing the parameters glottal closure, mucosal wave, and phase symmetry. RESULTS Ages at the time of surgery ranged from 10 to 52 years, and all of the patients were male. Preexisting vocal fold lesions included polyps, cysts, a sulcus, and mucosal bridges. Among the stroboscopic parameters, only the mucosal wave differed significantly between the preoperative and postoperative periods (P = 0.046). There were also significant postoperative improvements in the overall grade of dysphonia (P = 0.025) and in the degree of breathiness (P = 0.025). CONCLUSIONS The use of a bipedicled vocal fold mucosal flap appears to promote significant improvements in the mucosal wave and in voice quality. In the patients evaluated here, the technique was used without preoperative planning. However, it proved to be a safe and appropriate means of repairing mucosal defects in the vocal folds, with the potential to preserve rheological properties and promote healing with less chance of fibrosis.
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Affiliation(s)
- Domingos Hiroshi Tsuji
- Department of Otolaryngology of the Hospital das Clínicas of the University of São Paulo School of Medicine, São Paulo, Brazil.
| | - Vanessa Mika Kinchoku
- Department of Otolaryngology of the Hospital das Clínicas of the University of São Paulo School of Medicine, São Paulo, Brazil
| | - Rui Imamura
- Department of Otolaryngology of the Hospital das Clínicas of the University of São Paulo School of Medicine, São Paulo, Brazil
| | - Adriana Hachiya
- Department of Otolaryngology of the Hospital das Clínicas of the University of São Paulo School of Medicine, São Paulo, Brazil
| | - Rosiane Yamasaki
- Department of Otolaryngology of the Hospital das Clínicas of the University of São Paulo School of Medicine, São Paulo, Brazil
| | | | - Luiz Ubirajara Sennes
- Department of Otolaryngology of the Hospital das Clínicas of the University of São Paulo School of Medicine, São Paulo, Brazil
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Andrea M, Andrea M, Figueira ML. Self-perception of quality of life in patients with functional voice disorders: the effects of psychological and vocal acoustic variables. Eur Arch Otorhinolaryngol 2018; 275:2745-2754. [PMID: 30116878 DOI: 10.1007/s00405-018-5090-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 07/31/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE Functional voice disorders (FVD) are multifactorial and may have a significant impact on the patients' quality of life (QOL). The aim of this study was to explore and analyze the relationship between the VHI scores, psychological variables, and objective voice measurements, and to develop a psychological and/or vocal acoustic model for the overall self-perceived evaluation of quality of life for three different types of FVD. METHODS After ENT examination, 83 women were classified into three groups: psychogenic voice disorder (PVD = 39), primary muscle tension voice disorder (MTVD1 = 16), and secondary muscle tension voice disorder (MTVD2 = 28). All patients were evaluated according to a multidisciplinary assessment protocol, which included the self-evaluation of quality of life (Voice Handicap Index, VHI), psychological evaluation (Hamilton Rating Scales for Depression (HAM-D) and for Anxiety (HARS), and Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Auto questionnaire (TEMPS-A)), and vocal acoustic analysis [mean fundamental frequency (F0, Hz), jitter (local, %), shimmer (local, %), and harmonic-to-noise ratio (HNR, dB)]. RESULTS Our findings revealed a moderate impact on QOL, regardless of the type of FVD. There were significant correlations between VHI scores, psychological variables, and voice perturbation parameters, with the exception of the MTVD1 and MTVD2 groups. The stepwise multiple linear regression analysis suggested that QOL could be explained by: anxious temperament together with shimmer in PVD group, jitter in the MTVD1 group, and depressive temperament in the MTVD2 group. CONCLUSIONS Affective temperaments and/or voice perturbation parameters were meaningful predictors of self-evaluation of quality of life in patients with different types of FVD.
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Affiliation(s)
- Mafalda Andrea
- Department of Psychiatry, Santa Maria Hospital, Lisbon, Portugal.
| | - Mario Andrea
- University Clinic of Otolaryngology, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Maria Luísa Figueira
- University Clinic of Psychiatric and Medical Psychology, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
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Li X, Li J, Shi Y, Wang T, Zhang A, Shao N, Wang Z. Psychological intervention improves life quality of patients with laryngeal cancer. Patient Prefer Adherence 2017; 11:1723-1727. [PMID: 29042756 PMCID: PMC5634386 DOI: 10.2147/ppa.s147205] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The purpose of this study is to examine the effect of psychological intervention on the life quality of patients with laryngeal cancer. METHODS Two hundred and ten patients with laryngeal cancer were randomly assigned to the study group receiving psychological intervention and control group receiving routine nursing care. The Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), and the Europe Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) were used to evaluate life quality. RESULTS There were no significant differences in the scores of HAMD, HAMA, and EORTC QLQ-C30 between the 2 groups before treatment (P>0.05). After treatment, the scores in the study group were significantly different to those in the control group (P<0.05). In addition, the satisfaction rate and compliance rate of patients in the study group were increased, compared to the control group (P<0.05). CONCLUSION Psychological intervention is beneficial in improving life quality in patients with laryngeal cancer after surgery.
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Affiliation(s)
| | - Jingjing Li
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Yanxia Shi
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Ting Wang
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Aling Zhang
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Na Shao
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Zhenghui Wang
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, People’s Republic of China
- Correspondence: Zhenghui Wang, Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital, Xi’an Jiaotong University, 157 Xi Wu Road, Xi’an, Shaanxi Province 710004, People’s Republic of China, Tel +86 29 8767 9866, Fax +86 29 8767 8421, Email
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