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Konczak J, Bhaskaran D, Elangovan N, Oh J, Goding GS, Watson PJ. Effects of an 11-week vibro-tactile stimulation treatment on voice symptoms in laryngeal dystonia. Front Neurol 2024; 15:1403050. [PMID: 38872829 PMCID: PMC11169659 DOI: 10.3389/fneur.2024.1403050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 05/10/2024] [Indexed: 06/15/2024] Open
Abstract
Background Laryngeal dystonia is a task-specific focal dystonia of laryngeal muscles that impairs speech and voice production. At present, there is no cure for LD. The most common therapeutic option for patients with LD involves Botulinum neurotoxin injections. Objective Provide empirical evidence that non-invasive vibro-tactile stimulation (VTS) of the skin over the voice box can provide symptom relief to those affected by LD. Methods Single-group 11-week randomized controlled trial with a crossover between two dosages (20 min of VTS once or 3 times per week) self-administered in-home in two 4-week blocks. Acute effects of VTS on voice and speech were assessed in-lab at weeks 1, 6 and 11. Participants were randomized to receive either 40 Hz or 100 Hz VTS. Main outcome measures Primary: smoothed cepstral peak prominence (CPPS) of the voice signal to quantify voice and speech abnormalities, and perceived speech effort (PSE) ranked by participants as a measure of voice effort (scale 1-10). Secondary: number of voice breaks during continuous speech, the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) inventory as a measure of overall disease severity and the Voice Handicap Index 30-item self report. Results Thirty-nine people with a confirmed diagnosis of adductor-type LD (mean [SD] age, 60.3 [11.3] years; 18 women and 21 men) completed the study. A single application of VTS improved voice quality (median CPPS increase: 0.41 dB, 95% CI [0.20, 0.61]) and/or reduced voice effort (PSE) by at least 30% in up to 57% of participants across the three study visits. Effects lasted from less than 30 min to several days. There was no effect of dosage and no evidence that the acute therapeutic effects of VTS increased or decreased longitudinally over the 11-week study period. Both 100 and 40 Hz VTS induced measurable improvements in voice quality and speech effort. VTS induced an additional benefit to those receiving Botulinum toxin. Participants, not receiving Botulinum treatment also responded to VTS. Conclusion This study provides the first systematic empirical evidence that the prolonged use of laryngeal VTS can induce repeatable acute improvements in voice quality and reductions of voice effort in LD. Clinical trial registration ClinicalTrials.gov ID: NCT03746509.
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Affiliation(s)
- Jürgen Konczak
- Human Sensorimotor Control Laboratory, School of Kinesiology and Center for Clinical Movement Science, University of Minnesota, Minneapolis, MN, United States
| | - Divya Bhaskaran
- Human Sensorimotor Control Laboratory, School of Kinesiology and Center for Clinical Movement Science, University of Minnesota, Minneapolis, MN, United States
| | - Naveen Elangovan
- Human Sensorimotor Control Laboratory, School of Kinesiology and Center for Clinical Movement Science, University of Minnesota, Minneapolis, MN, United States
| | - Jinseok Oh
- Human Sensorimotor Control Laboratory, School of Kinesiology and Center for Clinical Movement Science, University of Minnesota, Minneapolis, MN, United States
| | - George S. Goding
- Department of Otolaryngology and Fairview Lion’s Voice Clinic, University of Minnesota, Minneapolis, MN, United States
| | - Peter J. Watson
- Department of Speech, Language and Hearing Sciences, University of Minnesota, Minneapolis, MN, United States
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White A, Carding P, Booth V, McGlashan J, Van Stan J, Logan P, Awad R. Pre- and post-operative voice therapy for benign vocal fold lesions: protocol for a non-randomised, multicentre feasibility trial with embedded process evaluation. Pilot Feasibility Stud 2024; 10:84. [PMID: 38783383 PMCID: PMC11112800 DOI: 10.1186/s40814-024-01508-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/10/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Management of benign vocal fold lesions (BVFLs) is variable with individuals receiving surgery, voice therapy, or a combination of these approaches. Some evidence suggests that the best outcomes may be achieved when patients are offered pre- and post-operative voice therapy in addition to phonosurgery, but what constitutes pre- and post-operative voice therapy is poorly described. The pre- and post-operative voice therapy (PAPOV) intervention has been developed and described according to the TIDieR checklist and Rehabilitation Treatment Specification System (RTSS) for voice. The PAPOV intervention is delivered by specialist speech and language therapists trained in the intervention and comprises 7 essential and 4 additional components, delivered in voice therapy sessions with patients who are having surgery on their vocal folds for removal of BVFLs. STUDY DESIGN Non-randomised, multicentre feasibility trial with embedded process evaluation. METHOD Forty patients from two sites who are due to undergo phonosurgery will be recruited to receive the PAPOV intervention. Measures of feasibility, including recruitment, retention, and adherence, will be assessed. The feasibility of gathering clinical and cost effectiveness data will be measured pre-treatment, then at 3 and 6 months post-operatively. An embedded process evaluation will be undertaken to explain feasibility findings. DISCUSSION This study will assess the feasibility of delivering a described voice therapy intervention protocol to patients who are undergoing surgery for removal of BVFLs. Findings will be used to inform the development and implementation of a subsequent effectiveness trial, should this be feasible. TRIAL REGISTRATION This trial has been prospectively registered on ISRCTN (date 4th January 2023), registration number 17438192, and can be viewed here: https://www.isrctn.com/ISRCTN17438192 .
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Affiliation(s)
- Anna White
- Centre for Rehabilitation & Ageing Research, Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, UK.
- Nottingham University Hospitals NHS Trust, Nottingham, UK.
| | - Paul Carding
- Oxford Institute of Applied Health Research, Oxford, UK
| | - Vicky Booth
- Centre for Rehabilitation & Ageing Research, Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | | | - Pip Logan
- Centre for Rehabilitation & Ageing Research, Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Rehab Awad
- University Hospital Lewisham NHS Trust, London, UK
- Kasr Al-Aini Hospital, Cairo University, Cairo, Egypt
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Chadwick KA, Andreadis K, Sulica L. Prospective Outcomes of Microlaryngoscopy Versus Office Laser Photoangiolysis for Vocal Fold Polyps. Laryngoscope 2024. [PMID: 38742623 DOI: 10.1002/lary.31484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/02/2024] [Accepted: 04/17/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVE(S) The objective of this study is to compare treatment outcomes for vocal fold polyps (VFPs) between operating room microlaryngoscopy and office-based photoangiolysis with the potassium titanyl phosphate (KTP) laser. METHODS Prospective nonrandomized cohort study of patients with VFPs undergoing microlaryngoscopy ("OR group") or KTP laser photoangiolysis ("KTP group"). Voice outcomes (patient-reported outcome measures [Voice Handicap Index-10 (VHI-10) and Singing VHI-10 (SVHI-10)], auditory-perceptual measures [Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V)], videostroboscopic characteristics [Voice-Vibratory Assessment of Laryngeal Imaging (VALI)], and acoustic and aerodynamic measures) were performed at baseline and regular intervals after intervention. RESULTS Forty-four subjects (17 OR group, 27 KTP group) with VFPs were enrolled. Mean VHI-10 significantly improved from baseline to each follow-up interval in both groups, except for the 1-2-week interval in the OR group. Mean SVHI-10 improved for both groups at some intervals. Growth curve models and time-to-event analyses for patient-reported outcomes did not differ between groups. There were significant improvements in all categories of auditory-perceptual voice quality and some categories of videostroboscopic characteristics in both groups. No significant trends were identified in acoustic and aerodynamic measures. Improvements in most outcomes did not significantly differ between groups or based on polyp size. There were no major complications. CONCLUSIONS Significant improvements in patient-reported voice outcomes measures, auditory-perceptual voice evaluation, and videostroboscopic characteristics occur following surgical treatment of vocal fold polyps with either microlaryngoscopy or office-based KTP laser. Long-term voice outcomes do not significantly differ between treatment modalities. LEVEL OF EVIDENCE Level 3 Laryngoscope, 2024.
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Affiliation(s)
- Keith A Chadwick
- Division of Otolaryngology-Head & Neck Surgery, Stony Brook University, Stony Brook, New York, USA
| | | | - Lucian Sulica
- Department of Otolaryngology-Head and Neck Surgery, The Sean Parker Institute for the Voice, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, New York, USA
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Contreras-Ruston F, Guzman M, Castillo-Allendes A, Cantor-Cutiva L, Behlau M. Auditory-perceptual Assessment of Healthy and Disordered Voices Using the Voice Deviation Scale. J Voice 2024; 38:654-659. [PMID: 34903393 DOI: 10.1016/j.jvoice.2021.10.017] [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: 07/15/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study aims to (1) determine the cut-off values of the Global Severity of vocal deviation on the Visual Analog Scale (VAS) from the numerical scale ratings, and (2) identify the cut-off values according to different degrees of vocal deviation used by Voice-Specialized Speech-Language Pathologists (SLP). STUDY DESIGN Prospective study. METHODS The auditory-perceptual assessment was performed by four SLPs using two protocols with different scales: the VAS and the 4-point numerical scale. Among the 211 voices analyzed, 147 corresponded to female participants, and 64 corresponded to males, plus 20% repeated voice samples. Participants were between 19 and 60 years. All of them were asked to count from 1 to 10 and were recorded in a sound-proof booth. For both protocols, the judges scored the overall severity. One SLP was excluded from the analysis due to inconsistency during the perceptual assessment. RESULTS For normal voice and mild deviations, overall severity cut-off score on the VAS was 21. For mild-moderate deviations, the cut-off was 55; and 81 points for moderate and severe deviations. The Area Under the Curve values correspond to 0.725, 0.905 and 0.851, respectively. CONCLUSIONS Our results suggest that the VAS is a good instrument to be used during voice assessment performed by Chilean SLPs. However, it evidences possible differences in voice analysis perception with other cut-off scores performed in other countries, which can be compared to future studies.
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Affiliation(s)
- Francisco Contreras-Ruston
- Speech-Language Pathology and Audiology Department, Universidad de Valparaíso, San Felipe, Chile; Parlab - Perception, Attention and Representation Lab, Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain.
| | - Marco Guzman
- Universidad de los Andes, Chile, Santiago, Chile
| | - Adrián Castillo-Allendes
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, Michigan
| | - Lady Cantor-Cutiva
- Department of Collective Health, Universidad Nacional de Colombia, Bogotá, Colombia; Program of Speech and Language Pathology, Universidad Manuela Beltrán, Bogotá, Colombia
| | - Mara Behlau
- CEV - Centro de Estudos da Voz, São Paulo, Brazil; Speech-Language Pathology and Audiology Department, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
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Mahalingam S, Venkatraman Y, Boominathan P. Cross-Cultural Adaptation and Validation of Consensus Auditory Perceptual Evaluation of Voice (CAPE-V): A Systematic Review. J Voice 2024; 38:630-640. [PMID: 34879984 DOI: 10.1016/j.jvoice.2021.10.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/10/2021] [Accepted: 10/11/2021] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Consensus Auditory Perceptual Evaluation of Voice (CAPE-V) is a widely used perceptual evaluation scale for voice assessment. It is adapted in many regional languages worldwide. This systematic review will help critically evaluate the methodologies used to adapt and establish CAPE-V as a valid and reliable tool. METHOD Authors reviewed literature in search engines (Scopus, Google Scholar, PubMed) to identify studies published in English between 2002-2020. The CAPE-V translated and adapted for linguistic or cultural variations were included for the review. The studies were compiled using the Mendeley Reference Manager and screened for title/abstract before shortlisting the studies. RESULTS The initial database had 3459 search results and after duplicates removal, 1535 articles were analysed. Thirteen studies were narrowed based on title/abstract screening. A final of ten studies were selected for the review. DISCUSSION/CONCLUSION This review provided a comprehensive understanding of the challenges encountered during cross-cultural adaptation and will help future researchers choose a suitable adaptation method.
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Affiliation(s)
- Shenbagavalli Mahalingam
- Department of Speech Language and Hearing Sciences, Sri Ramachandra Institute of Higher Education and Research (DU), Chennai, India
| | | | - Prakash Boominathan
- Department of Speech Language and Hearing Sciences, Sri Ramachandra Institute of Higher Education and Research (DU), Chennai, India.
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Calaf N, Garcia-Quintana D. Development and Validation of the Bilingual Catalan/Spanish Cross-Cultural Adaptation of the Consensus Auditory-Perceptual Evaluation of Voice. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:1072-1089. [PMID: 38527275 DOI: 10.1044/2024_jslhr-23-00536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
PURPOSE This study aimed to develop a valid and reliable bilingual version of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) for the auditory-perceptual evaluation of voice in Catalan and Spanish speakers. METHOD The development of this CAPE-V adaptation included Delphi methodology with 20 voice and speech experts reaching consensus on the optimal adapted terminology of the perceptual vocal attributes, considering also input from the original instrument authors. The adaptation and validation of vocal tasks followed a sequential validation procedure, with input from phoneticians and speech-language pathologists. Following pilot testing with a large sample of speech-language pathology students, a refined adapted version was empirically tested for validity and reliability. Concurrent validity was assessed by comparing the adapted CAPE-V with the reference Grade, Roughness, Breathiness, Asthenia, Strain scale. Construct validity was assessed through convergent and discriminant validity analysis. Intrarater and interrater reliability were assessed via intraclass correlation coefficient calculations. User experience was evaluated through a questionnaire. Scale properties were validated using a confusion matrix, and cutoff values were calculated to achieve the optimal balance between sensitivity and specificity. RESULTS Through a formalized consensus process, optimal Catalan/Spanish terminology was determined for the perceptual attributes of voice present in the CAPE-V. An adapted protocol of tasks was obtained that preserves the objectives of the original instrument and the relevance of the phonetic criteria in the target languages. The results demonstrated concurrent validity, construct validity, and intrarater reliability. Interrater reliability was found to depend on the extent to which evaluators shared their internal standards. The raters identified CAPE-V as an effective and preferred instrument. CONCLUSION An adapted, validated version of the CAPE-V is made available to clinical professionals for the evaluation of voice in Catalan and Spanish speakers.
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Affiliation(s)
- Neus Calaf
- Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Bellaterra, Spain
- Voice Analysis Lab, Biophysics Unit, School of Medicine, Autonomous University of Barcelona, Bellaterra, Spain
| | - David Garcia-Quintana
- Voice Analysis Lab, Biophysics Unit, School of Medicine, Autonomous University of Barcelona, Bellaterra, Spain
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Pommée T, Mbagira D, Morsomme D. French-Language Adaptation of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V). J Voice 2024:S0892-1997(24)00085-7. [PMID: 38582726 DOI: 10.1016/j.jvoice.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/11/2024] [Accepted: 03/12/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVES This study aimed to adapt the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) protocol for perceptual voice assessment to the French language. The primary objective was to achieve consensus among an international panel of voice experts on the content of the adapted protocol. METHODS To ensure the relevance and robustness of the French CAPE-V protocol, this study employed a systematic Delphi method and involved an international panel primarily comprising speech therapists and lecturers from France and Belgium. The multi-stage process included an initial panel size of 15 experts. Three rounds of online questionnaires, integrating both quantitative and qualitative data collection, were conducted. Participants provided feedback and ratings on various protocol elements until a consensus was reached. Adaptations targeted the choice of task stimuli (sustained vowel, sentence reading, semi-spontaneous speech), of the rating scales, and vocal quality terminology. RESULTS The Delphi process achieved consensus on all elements of the adapted CAPE-V protocol. Notably, the sustained vowel task saw consensus in favor of the vowel /a/. Sentence adaptations achieved substantial agreement, with the final set unanimously approved. The simple Visual Analog Scale emerged as the preferred rating scale. Agreement on terms for describing vocal qualities marked a crucial step in establishing a shared vocabulary among French-speaking voice experts. CONCLUSIONS The study successfully adapted the CAPE-V protocol for perceptual voice assessment to the French language through a systematic Delphi process. The final protocol closely resembles the original English version, maintaining its structure and core objectives. Consensus on sustained vowel tasks, sentence adaptations, rating scales, and vocal quality terminology indicates the relevance and robustness of the adapted protocol. Ongoing validation studies in France demonstrate the potential clinical utility of the adapted CAPE-V in French-speaking contexts, representing a significant step toward standardized and validated voice assessment tools for clinicians and researchers globally.
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Affiliation(s)
- Timothy Pommée
- Sunnybrook Research Institute, Toronto, Ontario, Canada; Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.
| | - Déborah Mbagira
- Research Unit for a Life-Course Perspective on Health and Education, Université de Liège, Liège, Belgium
| | - Dominique Morsomme
- Research Unit for a Life-Course Perspective on Health and Education, Université de Liège, Liège, Belgium
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Orbelo DM, Charney SA, Renkert E, Pietrowicz M, David Aka, Bayan SL, Ishikawa K. Vocal Effort and Acoustic Analysis of Gargle Phonation Versus Water Swallow in Patients With Muscle Tension Dysphonia: A Clinical Trial. J Voice 2024:S0892-1997(24)00057-2. [PMID: 38519331 DOI: 10.1016/j.jvoice.2024.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 03/24/2024]
Abstract
PURPOSE To determine the effects of gargle phonation (GP) on self-perceived vocal improvement, vocal effort, acoustic parameters, and speech rate in patients with muscle tension dysphonia (MTD). We hypothesized that GP would improve voice, reduce phonatory effort, and alter acoustic and speech measures. STUDY DESIGN Prospective randomized, single-blind cross-over clinical trial METHODS: Thirty-four participants (26 females, 8 males; average age 53 years) who were diagnosed with MTD completed the Voice Handicap Index-10 (VHI-10) and were assigned three study conditions: Baseline (B), GP, and Water Swallow (WS; sham), presented in one of two counterbalanced orders B-WS-GP (WS1st) or B-GP-WS (GP1st). Participants recorded stimuli from the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) and rated their perceived vocal effort and vocal improvement. F0, vocal intensity, cepstral peak prominence (CPP), and speaking rate were measured. RESULTS Average VHI-10 scores by group were 16 (min/max 2-29) for WS1st and 15 (min/max 3-40) for GP1st. About 73.5% reported more vocal improvement after GP, 17.65% after WS, and 8.8% noted no difference between conditions. Reduced effort was reported after GP, compared to B (P < 0.001) and WS (P = 0.005). Lower effort was also reported after the WS condition, compared to B (P = 0.011). Key acoustic findings included an increase in F0 after GP for sustained /i/ for females. CPP was significantly higher for females reading CAPE-V sentences after GP, when GP preceded WS, compared to B (P = 0.004) and WS (P = 0.003). Speech rate was faster for females after GP versus B (P = 0.029). CONCLUSIONS GP may be beneficial in the treatment of MTD. CPP may be a useful marker for vocal improvement after GP for women with mild MTD. Further studies would benefit from having more male participants and those with moderate and severe MTD.
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Affiliation(s)
- Diana M Orbelo
- Mayo Clinic Department of Otolaryngology, Rochester, Minnesota.
| | - Sara A Charney
- Mayo Clinic Department of Otolaryngology, Phoenix, Arizona
| | | | - Mary Pietrowicz
- National Center for Supercomputing Applications, Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana-Champaign, Illinois
| | - David Aka
- Mayo Clinic Department of Otolaryngology, Rochester, Minnesota
| | - Semirra L Bayan
- Mayo Clinic Department of Otolaryngology, Rochester, Minnesota
| | - Keiko Ishikawa
- University of Kentucky, Department of Communication Sciences and Disorders, Lexington, Kentucky
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Slavych BK, Zraick RI, Ruleman A. A Systematic Review of Voice-Related Patient-Reported Outcome Measures for Use with Adults. J Voice 2024; 38:544.e1-544.e14. [PMID: 34782227 DOI: 10.1016/j.jvoice.2021.09.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE This paper's purpose is to provide a resource for clinicians and researchers of select voice-related patient-reported outcome measures (PROMs) available in the English language. METHOD A systematic search for voice-related PROMs was conducted between September 2020 and July 17, 2021. Databases included APA PsychInfo, Nursing and Allied Health Source, MEDLINE via the EBSCO interface, and Science Direct. Reference lists for PROMs-related articles were mined for reference to PROMs protocols. RESULTS Thirty voice-related PROMs were identified and categorized as either developed primarily for use in the clinic (n = 12), developed primarily for use in a specific research study (n = 6), or translated into English for publication (n = 12). Twelve PROMs were summarized: Aging Voice Index, Disease Specific Self-Efficacy in Spasmodic Dysphonia, Evaluation of the Ability to Sing Easily, Evaluating Voice Disability - Quality of Life Questionnaire, Glottal Function Index, Linear Analog Scale of Assessment of Voice Quality, Quality of Life in Recurrent Respiratory Papillomatosis, Speech Disability Questionnaire, Trans Woman Voice Questionnaire, Vocal Cord Dysfunction Questionnaire, Vocal Fatigue Index, and the Vocal Tract Discomfort Scale. CONCLUSION The PROMs can be categorized into English-language voice-related PROMs developed primarily for clinical use, English-language PROMs developed primarily for research use, and English-language PROMs translated into English. The extent of reliability and validity testing completed varies in the PROMs developed primarily for clinical use. A PROM's psychometric properties as well as the language in which the PROM was tested, should guide clinicians and researchers as they consider which instrument(s) to use.
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Affiliation(s)
- Bonnie K Slavych
- Communication Disorders program, University of Central Missouri, Warrensburg, Missouri, USA.
| | - Richard I Zraick
- School of Communication Sciences and Disorders, University of Central Florida, Orlando, Florida, USA
| | - Alice Ruleman
- Communication Disorders program, University of Central Missouri, Warrensburg, Missouri, USA
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Jesus LMT, Castilho S, Alves M, Hall A. An Open Access Standardised Voice Evaluation Protocol. J Voice 2024; 38:357-365. [PMID: 34690030 DOI: 10.1016/j.jvoice.2021.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE A comprehensive protocol to evaluate voice quality can support a full characterisation of voice disorders and be used to plan voice interventions. The purpose of this study was to develop and validate a standardised protocol for voice assessment, contributing with a comprehensive and valuable tool for clinician practice and research. METHOD The initial structure and content of the protocol was based on an extensive literature review of existing voice assessment tools. The content validity was then assessed by a panel of voice specialist, using a modified Bland and Altman graphical method and the intraclass correlation coefficient (ICC). A group of participants with vocal pathology was finally assessed by two voice specialists on the same day (inter-rater reliability), and, on a second day, by a single evaluator (intra-rater reliability). Inter and intra-reliability were evaluated through Cohen's kappa (k) for nominal variables, and Spearman's Correlation Coefficient (ρ) for quantitative and ordinal variables. RESULTS The Bland and Altman analysis, revealed a reasonable agreement between the experts and the ICC values were lower than expected, but the confidence intervals were very wide. The intra-rater reliability of the protocol's nominal variables was almost perfect, with a mean k of 0.977; inter-rater reliability of nominal variables was also almost perfect, with a mean k of 0.893. The ordinal and quantitative variables revealed a very good to excellent relationship, with a mean ρ of 0.912. CONCLUSIONS Evidence of content validity, high intra and inter-rater reliability of a standardised protocol for voice assessment, have been shown. This protocol can be used to assess and collect data from patients, to train voice specialists and to develop reference voice databases. It has been designed to serve voice experts with diverse backgrounds and assessment needs.
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Affiliation(s)
- Luis M T Jesus
- Institute of Electronics and Informatics Engineering of Aveiro (IEETA) and School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal.
| | - Sara Castilho
- Hospital Arcebispo João Crisóstomo, Cantanhede, Portugal
| | | | - Andreia Hall
- Center for Research and Development in Mathematics and Applications (CIDMA) and Department of Mathematics (DMat), University of Aveiro, Aveiro, Portugal
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Walstrom A, Brehm SB, LeBorgne WD, Acord A, Gottliebson RO. Use of Terminology and the Effect of Training on Auditory-Perceptual Ratings of Speaking Voice by Singing Teachers. J Voice 2024; 38:543.e1-543.e11. [PMID: 34782224 DOI: 10.1016/j.jvoice.2021.09.036] [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: 07/01/2021] [Revised: 09/25/2021] [Accepted: 09/28/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate group differences between singing teachers and speech-language pathologists when rating dysphonic speaking voices and whether training using reference samples and the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) improves inter-rater reliability between and among the two groups. Differences in use of terminology and ratings could reveal potential for miscommunication in the team treatment of singers with voice disorders. STUDY DESIGN This is a prospective pre test post test cohort study with between and within group comparisons. METHODS Recorded samples of dysphonic speaking voices were rated by 18 experienced singing teachers with free written descriptions and an Overall Severity (OS) rating of 0-100. Participants were then trained in application of the CAPE-V with verbal definitions and reference samples exemplifying characteristics of disordered voice. Participants rated the samples a second time using the CAPE-V. The pre and post training ratings of participants were compared to composite ratings of six speech-language pathologists. RESULTS Descriptive statistics indicated the mean aggregate Overall Severity rating of speech-language pathologist (SLP) raters as 25.79 (SD = 6.10, SE = 2.49), as compared to 35.05 (SD = 12.72, SE = 3.00) for singing teachers. Differences in ratings were more pronounced in samples rated by SLPs as "mild" (OS 6-20) or "mild-moderate" (OS 21-35). ANOVA revealed statistically significant group differences between SLPs and singing teachers for the parameters Overall Severity (P = 0.0109, F = 7.8) and Strain (P = 0.0085, F = 8.35). While CAPE-V training did not significantly change the OS ratings of singing teachers, it did improve their inter-rater reliability from 0.67 pre training to 0.83 post training, with agreement similar to that of SLP raters (0.86). After training, participants responded "yes" to the presence of dysphonia in disordered samples more frequently. CONCLUSIONS The results support the recommendation of training singing teachers in perceptual evaluation of speaking voice to increase sensitivity to the presence of organic voice disorders and to encourage compatibility in terminology used among SLPs and singing teachers.
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Affiliation(s)
| | | | - Wendy D LeBorgne
- The Blaine Block Institute for Voice Analysis and Rehabilitation, Dayton, Ohio
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Sauder CL, Giliberto JP, Eadie TL. Sensitivity of Videolaryngostroboscopic Rating Tools to Differences in Dysphonia Severity. J Voice 2024:S0892-1997(24)00011-0. [PMID: 38307735 DOI: 10.1016/j.jvoice.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 02/04/2024]
Abstract
OBJECTIVES This study evaluated the validity of two videolaryngostroboscopic (VLS) rating tools to detect differences in VLS ratings between normophonic speakers, mild, and moderate-severely dysphonic speakers. METHODS Sixteen rigid VLS exams were obtained from four normophonic controls and 12 speakers with dysphonia (8 =mild, 4 =moderate-severe) secondary to laryngeal pathology. Eight clinicians rated nine vibratory VLS parameters for each exam using both the Voice-vibratory Assessment of Laryngeal Imaging (VALI) tool and a 100 mm visual analog scales (VAS). Ratings obtained for both right and left vocal folds (eg, mucosal wave, amplitude of vibration, nonvibrating portion) were averaged. One rating of overall severity of laryngeal function using a 100 mm VAS also was obtained. ANOVAs were used to evaluate differences in VLS parameters between three speaker groups (normophonic, mildly dysphonic, moderate-severely dysphonic) using these two rating tools. RESULTS There were statistically significant differences between controls and moderate-severely dysphonic speakers and for all VLS parameters except phase symmetry (P < 0.05) for both VALI and VAS ratings. Differences between mildly dysphonic and moderate-severely dysphonic and speakers were observed for 4/6 VALI ratings (mucosal wave, nonvibratory portions, phase closure, and regularity) and 5/6 parameters (mucosal wave, amplitude of vibration, nonvibratory portions, phase closure, and regularity) for VAS ratings. Significant differences between controls and mildly dysphonic speakers were not observed for VLS parameter rated using the VALI. There were significant differences between controls and mildly dysphonic speakers for 3/6 parameters (mucosal wave, amplitude of vibration, nonvibratory portion) using a VAS. Ratings of overall severity of laryngeal function differed between all levels of dysphonia severity. CONCLUSIONS Significant differences in VLS ratings were observed for comparisons of normophonic and moderate-severely dysphonic speakers and mild to moderately dysphonic speakers using the VALI and the VAS. However, the VAS scale appeared to better differentiate differences in VLS measures between normophonic speakers and those with mild dysphonia. Future studies should consider rating scale sensitivity when VLS rating tools are selected for clinical and research purposes.
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Affiliation(s)
- Cara L Sauder
- Department of Speech and Hearing Sciences, University of Washington, Seattle, Washington.
| | - J P Giliberto
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Tanya L Eadie
- Department of Speech and Hearing Sciences, University of Washington, Seattle, Washington; Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington
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13
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Lodhavia A, Kempster GB. Fidelity to the Consensus Auditory-Perceptual Analysis of Voice (CAPE-V): A Pilot Study. J Voice 2024:S0892-1997(23)00394-6. [PMID: 38185581 DOI: 10.1016/j.jvoice.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVES Auditory-perceptual measurements of voice are among the most common diagnostic tools used during a voice evaluation and are considered a gold standard for documenting voice disorders. The goal of this pilot study was to examine the fidelity of clinicians in the administration of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) and its published protocol. This investigation aimed to determine how the CAPE-V is being used by clinicians and researchers and the extent to which users deviate from the published procedure. STUDY DESIGN Survey METHODS: Data were collected by surveying a group (N = l7) of speech-language pathologists who regularly evaluate and treat patients with voice disorders. Survey results revealed that few of the sampled speech-language pathologists follow exactly the standardized instructions for administering the CAPE-V. Considerable variability in CAPE-V administration, including tasks and stimuli examined, was found across respondents. CONCLUSIONS This exploratory project may be used to develop a larger national survey study investigating fidelity to the CAPE-V and to motivate recommendations for possible revisions to the instrument and its protocol for administration.
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Affiliation(s)
- Anjli Lodhavia
- Department of Communication Disorders and Sciences, College of Health Sciences, Rush University, Rush University Medical Center, Chicago, Illinois; Department of Neurology, Division of Speech-Language Sciences and Disorders, Henry Ford Health, West Bloomfield, Michigan
| | - Gail B Kempster
- Department of Communication Disorders and Sciences, College of Health Sciences, Rush University, Rush University Medical Center, Chicago, Illinois; Associate Professor, Emerita, Department of Communication Disorders and Sciences, College of Health Sciences, Rush University, Rush University Medical Center, Chicago, Illinois.
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14
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Sauder CL, Kapsner-Smith MR, Simmons E, Meyer T, Doyle PC, Eadie TL. The Effect of Rating Method on Reliability of Judgments of Strain Across Populations. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:393-405. [PMID: 38060689 PMCID: PMC11000812 DOI: 10.1044/2023_ajslp-23-00174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/17/2023] [Accepted: 10/17/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE Variability in auditory-perceptual ratings of voice limits their utility, with the poorest reliability often noted for vocal strain. The purpose of this study was to determine whether an experimental method, called visual sort and rate (VSR), promoted stronger rater reliability than visual analog scale (VAS), for ratings of strain in two clinical populations: adductor laryngeal dystonia (ADLD) and vocal hyperfunction (VH). METHOD Connected speech samples from speakers with ADLD and VH as well as age- and sex-matched controls were selected from a database. Fifteen inexperienced listeners rated strain for two speaker sets (25 ADLD speakers and five controls; 25 VH speakers and five controls) across four rating blocks: VAS-ADLD, VSR-ADLD, VAS-VH, and VSR-VH. For the VAS task, listeners rated each speaker for strain using a vertically oriented 100-mm VAS. For the VSR task, stimuli were distributed into sets of samples with a range of severities in each set. Listeners sorted and ranked samples for strain within each set, and final ratings were captured on a vertically oriented 100-mm VAS. Intrarater reliability (Pearson's r) and interrater variability (mean of the squared differences between a listener's ratings and group mean ratings) were compared across rating methods and populations using two repeated-measures analyses of variance. RESULTS Intrarater reliability of strain was significantly stronger when listeners used VSR compared to VAS; listeners also showed significantly better intrarater reliability in ADLD than VH. Listeners demonstrated significantly less interrater variability (better reliability) when using VSR compared to VAS. No significant effect of population or interactions was found between listeners for measures of interrater variability. CONCLUSIONS VSR increases intrarater reliability for ratings of vocal strain in speakers with VH and ADLD. VSR decreases variability of auditory-perceptual judgments of strain between inexperienced listeners in these clinical populations. Future research should determine whether benefits of VSR extend to voice clinicians and/or clinical settings.
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Affiliation(s)
- Cara L. Sauder
- Department of Speech & Hearing Sciences, University of Washington, Seattle
| | | | - Emily Simmons
- Department of Speech & Hearing Sciences, University of Washington, Seattle
| | - Tanya Meyer
- Department of Otolaryngology—Head & Neck Surgery, University of Washington School of Medicine, Seattle
| | - Philip C. Doyle
- Division of Laryngology, Department of Otolaryngology—Head & Neck Surgery, Stanford University School of Medicine, CA
| | - Tanya L. Eadie
- Department of Speech & Hearing Sciences, University of Washington, Seattle
- Department of Otolaryngology—Head & Neck Surgery, University of Washington School of Medicine, Seattle
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15
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Fujiki RB, Sanders PW, Anthony BP, Parker NP, Sivasankar MP, Halum S. Can Resident Auditory-Perceptual Voice Assessments Predict Medical Urgency of Voice Disorders? J Voice 2024; 38:181-188. [PMID: 34479778 DOI: 10.1016/j.jvoice.2021.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND/OBJECTIVES 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. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
| | | | - Benjamin P Anthony
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine
| | - Noah P Parker
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine
| | | | - Stacey Halum
- Department of Speech, Language, and Hearing Sciences, Purdue University; Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine.
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16
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Castillo-Allendes A, Codino J, Cantor-Cutiva LC, Nudelman CJ, Rubin AD, Barsties v. Latoszek B, Hunter EJ. Clinical Utility and Validation of the Acoustic Voice Quality and Acoustic Breathiness Indexes for Voice Disorder Assessment in English Speakers. J Clin Med 2023; 12:7679. [PMID: 38137748 PMCID: PMC10743486 DOI: 10.3390/jcm12247679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 12/12/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND While several acoustic voice metrics are available for clinical voice assessment, there remains a significant need for reliable and ecologically valid tools. The Acoustic Voice Quality Index version 03.01 (AVQI-3) and Acoustic Breathiness Index (ABI) hold potential due to their comprehensive assessment approach, incorporating diverse voice aspects. However, these tools still need to be validated in English-speaking populations. METHODS This study assessed the discriminatory accuracy and validity of AVQI-3 and ABI in 197 participants, including 148 with voice disorders. Voice samples were collected, followed by AVQI-3 and ABI calculations. Additionally, auditory-perceptual assessments were conducted by a panel of speech-language pathologists. RESULTS AVQI-3 and ABI effectively identified disordered voice quality, evidenced by high accuracy (AUCs: 0.84, 0.89), sensitivity, and specificity (thresholds: AVQI-3 = 1.17, ABI = 2.35). Strong positive correlations were observed with subjective voice quality assessments (rs = 0.72, rs = 0.77, p < 0.001). CONCLUSIONS The study highlights AVQI-3 and ABI as promising instruments for clinically assessing voice disorders in U.S. English speakers, underscoring their utility in clinical practice and voice research.
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Affiliation(s)
- Adrián Castillo-Allendes
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, MI 48824, USA; (A.C.-A.)
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, IA 52242, USA
| | - Juliana Codino
- Lakeshore Professional Voice Center, Lakeshore Ear, Nose & Throat Center, St. Clair Shores, MI 48081, USA
| | - Lady Catherine Cantor-Cutiva
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, MI 48824, USA; (A.C.-A.)
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, IA 52242, USA
| | - Charles J. Nudelman
- Department of Speech and Hearing Science, University of Illinois Urbana-Champaign, Champaign, IL 61820, USA
| | - Adam D. Rubin
- Lakeshore Professional Voice Center, Lakeshore Ear, Nose & Throat Center, St. Clair Shores, MI 48081, USA
| | | | - Eric J. Hunter
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, MI 48824, USA; (A.C.-A.)
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, IA 52242, USA
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17
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Norotsky RL, Dahl KL, Cocroft S, Sauder C, Tracy LF, Stepp CE. Does Implicit Racial Bias Affect Auditory-Perceptual Evaluations of Dysphonic Voices? J Voice 2023:S0892-1997(23)00383-1. [PMID: 38065808 PMCID: PMC11156794 DOI: 10.1016/j.jvoice.2023.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 11/22/2023] [Accepted: 11/27/2023] [Indexed: 01/07/2024]
Abstract
PURPOSE The purpose of this study was to understand the role of implicit racial bias in auditory-perceptual evaluations of dysphonic voices by determining if a biasing effect exists for novice listeners in their auditory-perceptual ratings of Black and White speakers. METHOD Thirty speech-language pathology graduate students at Boston University listened to audio files of 20 Black speakers and 20 White speakers of General American English with voice disorders. Listeners rated the overall severity of dysphonia of each voice heard using a 100-unit visual analog scale and completed the Harvard Implicit Association Test (IAT) to measure their implicit racial bias. RESULTS Both Black and White speakers were rated as less severely dysphonic when their race was labeled as Black. No significant relationship was found between Harvard IAT scores and differences in severity ratings by race labeling condition. CONCLUSIONS These findings suggest a minimizing bias in the evaluation of dysphonia for Black patients with voice disorders. These results contribute to the understanding of how a patient's race may impact their visit with a clinician. Further research is needed to determine the most effective interventions for implicit bias retraining and the additional ways that implicit racial bias impacts comprehensive voice evaluations.
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Affiliation(s)
- Rachel L Norotsky
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, Massachusetts.
| | - Kimberly L Dahl
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, Massachusetts
| | - Sarah Cocroft
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, Massachusetts
| | - Cara Sauder
- Department of Speech and Hearing Sciences, University of Washington, Seattle, Washington
| | - Lauren F Tracy
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, Massachusetts; Department of Otolaryngology - Head and Neck Surgery, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Cara E Stepp
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, Massachusetts; Department of Otolaryngology - Head and Neck Surgery, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts; Department of Biomedical Engineering, Boston University, Boston, Massachusetts
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18
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Mokhlesin M, Kohansal A, Tahmasebi N, Dehqan A, Tohidast SA, Mansuri B. The Effect of Adding Cricothyroid Visor Maneuver to Voice Facilitating Techniques on Improving Voice in Individuals With Primary Muscle Tension Dysphonia: A Pilot Randomized Clinical Trial. J Voice 2023:S0892-1997(23)00317-X. [PMID: 38044169 DOI: 10.1016/j.jvoice.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/05/2023] [Accepted: 10/05/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVES The purpose of the present study was to examine the effect of adding a cricothyroid visor maneuver to conventional voice-facilitating techniques on voice quality and reported symptoms in patients with primary muscle tension dysphonia. METHODS This was a double-blind two parallel-group clinical trial in which 20 adult patients participated through convenience sampling. Participants were allocated to intervention (combined treatment) and control (conventional treatment) groups. The intervention was performed for both groups for five sessions, twice a week. The two groups were compared after the intervention for primary outcome measures including maximum phonation time, jitter, shimmer, harmonic-to-noise ratio, and consensus auditory-perceptual evaluation of voice, and for secondary outcome measures including the voice handicap index, the voice activity and participation profile, the voice-related pain scale, and the vocal tract discomfort scale. RESULTS Within-group primary outcome comparison showed that both groups showed significant improvement in maximum phonation time and consensus auditory-perceptual evaluation of voice indices after treatment. the between-group comparison showed that the maximum phonation time increased significantly in the intervention group after the treatment (P = 0.03) and the effect size was large (es = 1.05). within-group secondary outcome comparison showed that all indices improved significantly in both groups except for the voice-related pain scale frequency. The between-group comparison showed that except for voice-related pain scale frequency, the intervention group reported significantly more improvement in all other self-reporting indices with a large effect size. CONCLUSIONS The study showed that adding cricothyroid visor maneuver to conventional voice-facilitating techniques, compared to conventional treatment alone, resulted in a significant increase in maximum phonation time, reduction in pain and vocal tract discomfort, increase in activity and participation, and improvement in voice-handicapped index in primary muscle tension dysphonia patients. Therefore adding cricothyroid visor maneuver to other treatments can be an effective method in improving primary muscle tension dysphonia which needs more studies in the future.
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Affiliation(s)
- Maryam Mokhlesin
- Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Azin Kohansal
- Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Neda Tahmasebi
- Department of Speech Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ali Dehqan
- Rehabilitation Sciences Research Center, Zahedan University of Medical Sciences, Zahedan, Iran; Speech Therapy Dept., Rehabilitation Faculty, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Seyed Abolfazl Tohidast
- Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Banafshe Mansuri
- Department of Speech Therapy, School of Rehabilitation Sciences, Semnan University of Medical Sciences, Semnan, Iran.
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19
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Nayebian R, Darouie A, Hasanvand A, Vahedi M. Cepstral and Perceptual Investigations of Voice in Speech and Language Pathologists with Vocal Fatigue. Indian J Otolaryngol Head Neck Surg 2023; 75:3696-3702. [PMID: 37974796 PMCID: PMC10645846 DOI: 10.1007/s12070-023-04048-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 06/27/2023] [Indexed: 11/19/2023] Open
Abstract
Vocal fatigue is known as a hyperfunctional voice disorder that can lead to other conditions, such as muscle tension dysphonia (MTD). Speech and language pathologists (SLPs) are professional voice users who may suffer from vocal fatigue due to heavy vocal demands. This study aimed at investigating the cepstral and perceptual dimensions of voice and their correlation in the SLPs with vocal fatigue. Twenty-six SLPs and senior speech therapy students (mean age = 27.11 ± 6.8 yrs), including men (n = 5) and women (n = 21), participated in this descriptive cross-sectional study. They had vocal fatigue according to the Vocal Fatigue Index (VFI). In acoustic assessment, cepstral analysis (CPP and CPPS) was performed using Praat software. The Persian version of Consensus Auditory Perceptual Evaluation of Voice (CAPE-V) was used to evaluate the overall severity of dysphonia. The correlation between these two evaluations was also investigated using IBM SPSS Statistics software version 23. Results revealed that the mean CPPS (13.716 ± 2.084) was lower than the cutoff point. Perceptual findings indicated that the mean overall severity (10.557 ± 11.210) fell in the normal variability of voice quality (NVVQ) range. In addition, cepstral and perceptual evaluations had no significant correlation (P > 0/05). The findings showed that auditory-perceptual evaluation considered the gold standard method of voice evaluation, cannot solely identify vocal fatigue. However, cepstral measures can help provide a more objective profile of vocal function in SLPs with vocal fatigue. Therefore, both of these evaluations are recommended for voice assessment of vocal fatigue.
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Affiliation(s)
- Rezvane Nayebian
- Department of Speech Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Akbar Darouie
- Department of Speech Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Arezoo Hasanvand
- Department of Speech Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohsen Vahedi
- Department of Biostatistics and Epidemiology, Psychosis Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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20
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Griffin L, Kamarunas E, Smith JB, Kuo C, O'Donoghue C. Dysphonia Outperforms Voice Change as a Clinical Predictor of Dysphagia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:2676-2690. [PMID: 37669615 DOI: 10.1044/2023_ajslp-23-00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
PURPOSE Changes in voice quality after consuming food or drink have been used as a clinical indicator of dysphagia during the clinical swallowing evaluation (CSE); however, there is conflicting evidence of its efficacy. This study investigated if dysphonia and/or voice change after swallowing are valid predictors of penetration, aspiration, or pharyngeal residue. Our approach aimed to improve current methodologies by collecting voice samples in the fluoroscopy suite, implementing rater training to improve interrater reliability and utilizing continuous measurement scales, allowing for regression analyses. METHOD In this prospective study, 30 adults (aged 49-97 years) referred for a videofluoroscopic swallowing study (VFSS) were audio-recorded completing a sustained /i/ prior to VFSS and again after swallowing each bolus during the VFSS. Swallowing function was measured using the reorganized Penetration-Aspiration Scale and the Normalized Residue Ratio Scale. Following listener training, 84 voice samples were perceptually rated using the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V). Ordinal and logistic regression were used to determine whether voice quality and voice quality change after swallowing were predictors of airway invasion and pharyngeal clearance. RESULTS Results indicated that the presence of dysphonia at baseline during a sustained /i/ task as measured by the CAPE-V predicted airway invasion but not pharyngeal residue. Voice change after swallowing associated with vowel /i/ production as measured by the CAPE-V did not predict either dysphagia measure. CONCLUSION These results indicate that voice change during a sustained /i/ after swallowing appears unrelated to airway invasion or pharyngeal residue; however, in the absence of known laryngeal pathology, dysphonia prior to a CSE should alert speech-language pathologists of a possible comorbid dysphagia.
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Affiliation(s)
- Lindsay Griffin
- Department of Communication Sciences & Disorders, School of Communication, Emerson College, Boston, MA
- Department of Communication Sciences and Disorders, College of Health and Behavioral Studies, James Madison University, Harrisonburg, VA
- Voice and Swallow Clinic, Sentara Rockingham Memorial Hospital, Harrisonburg, VA
| | - Erin Kamarunas
- Department of Communication Sciences and Disorders, College of Health and Behavioral Studies, James Madison University, Harrisonburg, VA
- Voice and Swallow Clinic, Sentara Rockingham Memorial Hospital, Harrisonburg, VA
| | - Julian Bergen Smith
- Department of Communication Sciences and Disorders, College of Health and Behavioral Studies, James Madison University, Harrisonburg, VA
- Department of Communication Disorders, College of Health and Human Services, Southern Connecticut State University, New Haven
| | - Christina Kuo
- Department of Communication Sciences and Disorders, College of Health and Behavioral Studies, James Madison University, Harrisonburg, VA
| | - Cynthia O'Donoghue
- Department of Communication Sciences and Disorders, College of Health and Behavioral Studies, James Madison University, Harrisonburg, VA
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21
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Paiva MAAD, Machado LDS, Lopes LW. Proposal of requirements for the development of a training simulator for the auditory-perceptual judgment of voice. Codas 2023; 35:e20220209. [PMID: 37820100 DOI: 10.1590/2317-1782/20232022209pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/05/2022] [Indexed: 10/13/2023] Open
Abstract
PURPOSE to identify a set of requirements for the development of an auditory-perceptual training simulator (APT) based on the experience of professors who provide APT. METHODS This is a cross-sectional, descriptive study with a quantitative approach. Twenty-two professors answered an online questionnaire containing 31 items related to APT, involving items about the professional profile, conditions for APT in undergraduate and postgraduate courses in Speech Therapy, APT structure, and evaluation of the APT effect. RESULT it was observed that there is a variation in APT procedures performed in Brazil. The main requirements indicated by the respondents for the APT involve the use of synthesized voices in the initial moments, followed by human voices later; the use of speech tasks with sustained vowels and connected speech; the insertion of complementary information such as gender, age, the profession of the speaker and the spectrography of the vocal signal; training with a minimum time of six hours; the evaluation of the training effect by comparing intra- and inter-judge agreement before and after training; the addition of the parameters of general degree of vocal deviation, roughness, breathiness, and strain; the use of validated continuous and numerical scales; and offering it from the second year of the undergraduate program. CONCLUSION although there is variability in the response of experts, a minimum set of requirements indicated for performing APT with new judges was identified.
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22
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Hseu AF, Spencer GP, Jo S, Kawai K, Nuss RC. Pediatric Dysphonia: When to Refer. Clin Pediatr (Phila) 2023; 62:1261-1268. [PMID: 36856137 DOI: 10.1177/00099228231157957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
The reported prevalence of voice disorders in the pediatric population varies widely between studies, ranging from 3.9% to 23%. Despite this, not all children with dysphonia are referred to a voice specialist for further evaluation. The objective of this study is to examine the relationship between dysphonia history, voice assessment, and laryngeal findings to help guide referrals of dysphonic children. A retrospective review was conducted of pediatric patients at a tertiary voice clinic between January 2014 and December 2017. Data including dates of presentation, demographics, co-morbidities, presenting symptoms, laryngeal exam findings, Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) scores, and Pediatric Voice Handicap Index (pVHI) scores were collected and analyzed. Of 475 patients initially identified, 459 met inclusion criteria and were reviewed. In all, 272 (59.3%) were male and 187 (40.7%) were female. Mean age at first presentation was 8.6 years old (range: 2-18). Males were more likely to present at a younger age than females. CAPE-V data were available for 439 patients, and pVHI data were available for 109 patients. The mean CAPE-V Overall Severity score was 38.2. The mean total pVHI score was 25.4. Males had higher CAPE-V Overall Severity (40.0 vs. 35.4), Roughness (32.2 vs. 27.6), and Strain scores (37.2 vs. 32.4) than females. Patient pVHI scores did not differ by gender. In all, 283 patients self-reported a length of symptoms prior to evaluation. Children with a longer duration of symptoms prior to evaluation had higher CAPE-V Overall Severity scores. Diagnoses of vocal fold movement impairment and benign vocal fold lesions that were not nodules were associated with higher average CAPE-V Overall Severity scores. Overall, 310 patients (67.5%) were recommended intervention for their dysphonia. These patients had higher CAPE-V Overall Severity scores than those who were solely recommended observation (42.8 vs. 28.0). Males were more likely than females to present with dysphonia and presented with more severe perceptual dysphonia scores on average. The length of symptoms and certain diagnoses correlated with higher CAPE-V Scores. Referrals to a pediatric voice clinic should be considered in patients with a dysphonia history lasting greater than 3 months and in patients with more severe symptoms.
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Affiliation(s)
- Anne F Hseu
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - Grant P Spencer
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
| | - Stacy Jo
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
| | - Kosuke Kawai
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
| | - Roger C Nuss
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
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Konnai R, Van Harn M, Silbergleit A. Conversational Vocal Intensity in Parkinson's Disease: Treatment and Environmental Comparisons. J Voice 2023; 37:707-715. [PMID: 34134903 DOI: 10.1016/j.jvoice.2021.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/06/2021] [Accepted: 04/08/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Vibrotactile Feedback (VF) using wearable devices is an emerging treatment option for hypophonia in Individuals with Parkinson's disease (IwPD). Studies evaluating the effectiveness of VF in improving conversational vocal intensity in real-life environment in IwPD are limited. OBJECTIVE To determine the effect of VF on conversational vocal intensity and compare vocal intensity between a) clinic and real-life environment b) VF and Lee Silverman Voice Treatment (LSVT LOUD®)vs. VF alone in IwPD using a portable voice monitor (VocaLog2). METHODS Eight individuals with hypophonia secondary to PD were randomly assigned to two treatment groups- VF and LSVT LOUD® (Group 1) and VF (Group 2). VF was provided using VocaLog2 device. Duration of treatment was 4 weeks for both groups. Vocal intensity was measured in the real-life environment at baseline, during treatment, and at one-month follow-up. Vocal intensity in clinic was obtained at baseline and one-month follow-up. Voice Handicap Index (VHI) questionnaire was administered at baseline and one-month follow-up. RESULTS There was no significant difference in conversational vocal intensity between a) clinic and real-life environment at any point of time b) baseline and follow up for both treatment groups c) the two treatment groups at baseline, during each of the 4 weeks of treatment and at follow up d) VHI baseline and one month follow up scores. CONCLUSION VF, including when combined with LSVT LOUD®, is limited in improving conversational vocal intensity in real-life in IwPD. The effects of frequency and duration of VF on conversational vocal intensity must be systematically investigated using large scale studies in IwPD.
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Affiliation(s)
- Ramya Konnai
- Department of Neurology, Henry Ford Health System, West Bloomfield, Michigan.
| | - Meredith Van Harn
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan
| | - Alice Silbergleit
- Department of Neurology, Henry Ford Health System, West Bloomfield, Michigan
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Sauder C, Giliberto JP, Eadie T. The effect of the auditory signal on videolaryngostroboscopy ratings and interpretation. J Voice 2023; 37:799.e1-799.e11. [PMID: 34112550 DOI: 10.1016/j.jvoice.2021.04.022] [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: 02/17/2021] [Revised: 04/25/2021] [Accepted: 04/27/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The primary aim of this study was to examine the effect of the videolaryngostroboscopic auditory signal on videolaryngostroboscopy (VLS) ratings and interpretation in normophonic and dysphonic speakers. STUDY DESIGN Prospective repeated measures design METHOD: Eight speech-language pathologists evaluated rigid VLS exams obtained from 12 dysphonic speakers with vocal fold pathology and 4 normophonic speakers with normal VLS exams. VLS exams were evaluated with the auditory signal present and absent with a washout period between rating sessions. VLS measures were obtained using the Voice-vibratory Assessment of Laryngeal Imaging (VALI) and a 100mm visual analog scale (VAS). The effects of the auditory signal and its interaction with voice quality severity on 9 VLS ratings, diagnostic billing codes, and treatment recommendations were examined. RESULTS There was no effect of auditory information on VLS measures or overall severity of laryngeal function evaluated using the VAS (ps > 0.05). There was a main effect of auditory information and a significant interaction with voice quality severity for only one VLS measure (non-vibrating portion-left) evaluated using the VALI (P = 0.05). Post-hoc analysis for this rating showed significant increases (t-test adjusted P < 0.05) when voice quality severity was moderate-severe (M = 4.8%; SD = 1.65%) and auditory information was present. Agreement in individual clinician's selection of diagnostic codes (73%) and treatment recommendations (65.6%) when auditory cues were present and absent was moderate to high. CONCLUSION The presence of the videolaryngostroboscopic auditory signal had a minimal effect on VLS ratings, treatment recommendations, or diagnostic billing codes.
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Affiliation(s)
- Cara Sauder
- Department of Speech and Hearing Sciences, University of Washington, Seattle, Washington.
| | - John Paul Giliberto
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington
| | - Tanya Eadie
- Department of Speech and Hearing Sciences, University of Washington, Seattle, Washington; Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington
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25
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Axiotakis LG, Enver N, Kennedy EL, Duncan KA, Pitman MJ. Duration of Clinical Response After In-Office Steroid Injection for Vocal Fold Scar. Laryngoscope 2023; 133:2333-2339. [PMID: 36594519 DOI: 10.1002/lary.30539] [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: 10/04/2022] [Revised: 11/24/2022] [Accepted: 12/14/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To assess the duration of clinical response after in-office vocal fold steroid injection (VFSI) for vocal fold (VF) scar. METHODS Demographic and clinical data for in-office VFSI occurring from 2017 to 2020 were collected. Two Speech-Language Pathologists (SLPs) used perceptual evaluation of voice and functional scales to evaluate blinded voice and laryngovideostroboscopy (LVS) samples collected pre- and post-injection across multiple timepoints. RESULTS Blinded SLP ratings were used for 30 individual VFs undergoing initial injection in 18 patients. Persistent improvement in voice past 6 months was seen in 57% of patients after VFSI. Multiple measures of voice and amplitude, percent vibrating tissue, and closed phase predominance significantly improved at various follow-up timepoints on average. CONCLUSION Accounting for patient heterogeneity and disease progression, in-office VFSI for VF scar is associated with sustained improvement in a subset of patients. Approximately half of patients can expect to experience a lasting improvement in voice. Future studies of larger scale are required to identify patient factors associated with long-term benefit. LEVEL OF EVIDENCE 4 Laryngoscope, 133:2333-2339, 2023.
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Affiliation(s)
- Lucas G Axiotakis
- Center for Voice and Swallowing, Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Necati Enver
- Center for Voice and Swallowing, Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Evan L Kennedy
- Center for Voice and Swallowing, Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Kimberly A Duncan
- Center for Voice and Swallowing, Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Michael J Pitman
- Center for Voice and Swallowing, Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York, USA
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Thompson A, Hirsch ME, Lansford KL, Kim Y. Vowel Acoustics as Predictors of Speech Intelligibility in Dysarthria. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:3100-3114. [PMID: 36795536 PMCID: PMC10569402 DOI: 10.1044/2022_jslhr-22-00287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 09/27/2022] [Accepted: 12/12/2022] [Indexed: 06/18/2023]
Abstract
PURPOSE This study sought to determine if alternative vowel space area (VSA) measures (i.e., novel trajectory-based measures: vowel space hull area and vowel space density) predicted speech intelligibility to the same extent as two traditional vowel measures (i.e., token-based measures: VSA and corner dispersion) in speakers with dysarthria. Additionally, this study examined if the strength of the relationship between acoustic vowel measures and intelligibility differed based on how intelligibility was measured (i.e., orthographic transcriptions [OTs] and visual analog scale [VAS] ratings). METHOD The Grandfather Passage was read aloud by 40 speakers with dysarthria of varying etiologies, including Parkinson's disease (n = 10), amyotrophic lateral sclerosis (n = 10), Huntington's disease (n = 10), and cerebellar ataxia (n = 10). Token- and trajectory-based acoustic vowel measures were calculated from the passage. Naïve listeners (N = 140) were recruited via crowdsourcing to provide OTs and VAS intelligibility ratings. Hierarchical linear regression models were created to model OTs and VAS intelligibility ratings using the acoustic vowel measures as predictors. RESULTS Traditional VSA was the sole significant predictor of speech intelligibility for both the OTs (R 2 = .259) and VAS (R 2 = .236) models. In contrast, the trajectory-based measures were not significant predictors of intelligibility. Additionally, the OTs and VAS intelligibility ratings conveyed similar information. CONCLUSIONS The findings suggest that traditional token-based vowel measures better predict intelligibility than trajectory-based measures. Additionally, the findings suggest that VAS methods are comparable to OT methods for estimating speech intelligibility for research purposes.
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Affiliation(s)
- Austin Thompson
- School of Communication Science and Disorders, Florida State University, Tallahassee
| | - Micah E. Hirsch
- School of Communication Science and Disorders, Florida State University, Tallahassee
| | - Kaitlin L. Lansford
- School of Communication Science and Disorders, Florida State University, Tallahassee
| | - Yunjung Kim
- School of Communication Science and Disorders, Florida State University, Tallahassee
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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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Buckley DP, Abur D, Stepp CE. Normative Values of Cepstral Peak Prominence Measures in Typical Speakers by Sex, Speech Stimuli, and Software Type Across the Life Span. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:1565-1577. [PMID: 37257202 PMCID: PMC10473385 DOI: 10.1044/2023_ajslp-22-00264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/15/2022] [Accepted: 03/16/2023] [Indexed: 06/02/2023]
Abstract
PURPOSE The purpose of this study was to determine normative values for cepstral peak prominence measures across the life span as a function of sex using clinically relevant stimuli (/ɑ/, /i/, and two sentences of The Rainbow Passage) and two commonly used software types: Praat (Version 6.0.50) and Analysis of Dysphonia in Speech and Voice (ADSV). METHOD One hundred fifty speakers (75 males, 75 females; evenly distributed into three age groups) without voice disorders aged 18-91 years were recorded via headset microphone in a sound-treated booth. Cepstral measures were analyzed using common analysis methods in Praat and ADSV by sex, stimuli, and software type. Kruskal-Wallis tests and post hoc Mood's Median tests for significant factors were performed on cepstral measures to assess the effects of age group, sex, stimuli, and software type. RESULTS The results revealed statistically significant effects of sex, stimuli, and software type on cepstral measures, but no statistical effect of age group on cepstral values. Females had lower average cepstral values compared to males. Across stimuli, the highest average cepstral measure was found for sustained /ɑ/, followed by sustained /i/, and then of the two sentences of The Rainbow Passage. Average cepstral measures in Praat were higher than those from ADSV. CONCLUSIONS The current work did not find a statistical effect of age group on cepstral values; thus, normative cepstral values were reported by sex, stimuli, and software type. Future work should examine the applicability of these normative values for discriminating speakers with and without voice disorders.
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Affiliation(s)
- Daniel P. Buckley
- Department of Speech, Language, and Hearing Sciences, Boston University, MA
- Department of Otolaryngology – Head and Neck Surgery, Boston University School of Medicine, MA
| | - Defne Abur
- Department of Speech, Language, and Hearing Sciences, Boston University, MA
- Department of Computational Linguistics, University of Groningen, the Netherlands
- Research School of Behavioral and Cognitive Neurosciences, University of Groningen, the Netherlands
| | - Cara E. Stepp
- Department of Speech, Language, and Hearing Sciences, Boston University, MA
- Department of Otolaryngology – Head and Neck Surgery, Boston University School of Medicine, MA
- Department of Biomedical Engineering, Boston University, MA
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van der Woerd B, Chen Z, Flemotomos N, Oljaca M, Sund LT, Narayanan S, Johns MM. A Machine-Learning Algorithm for the Automated Perceptual Evaluation of Dysphonia Severity. J Voice 2023:S0892-1997(23)00179-0. [PMID: 37429808 DOI: 10.1016/j.jvoice.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/07/2023] [Accepted: 06/07/2023] [Indexed: 07/12/2023]
Abstract
OBJECTIVES Auditory-perceptual assessments are the gold standard for assessing voice quality. This project aims to develop a machine-learning model for measuring perceptual dysphonia severity of audio samples consistent with assessments by expert raters. METHODS The Perceptual Voice Qualities Database samples were used, including sustained vowel and Consensus Auditory-Perceptual Evaluation of Voice sentences, which were previously expertly rated on a 0-100 scale. The OpenSMILE (audEERING GmbH, Gilching, Germany) toolkit was used to extract acoustic (Mel-Frequency Cepstral Coefficient-based, n = 1428) and prosodic (n = 152) features, pitch onsets, and recording duration. We utilized a support vector machine and these features (n = 1582) for automated assessment of dysphonia severity. Recordings were separated into vowels (V) and sentences (S) and features were extracted separately from each. Final voice quality predictions were made by combining the features extracted from the individual components with the whole audio (WA) sample (three file sets: S, V, WA). RESULTS This algorithm has a high correlation (r = 0.847) with estimates of expert raters. The root mean square error was 13.36. Increasing signal complexity resulted in better estimation of dysphonia, whereby combining the features outperformed WA, S, and V sets individually. CONCLUSION A novel machine-learning algorithm was able to perform perceptual estimates of dysphonia severity using standardized audio samples on a 100-point scale. This was highly correlated to expert raters. This suggests that ML algorithms could offer an objective method for evaluating voice samples for dysphonia severity. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Benjamin van der Woerd
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, McMaster University, Hamilton, Ontario, Canada.
| | - Zhuohao Chen
- Department of Electrical and Computer Engineering, University of Southern California, Los Angeles, California
| | - Nikolaos Flemotomos
- Department of Electrical and Computer Engineering, University of Southern California, Los Angeles, California
| | - Maria Oljaca
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Lauren Timmons Sund
- Department of Otolaryngology-Head & Neck Surgery, University of Southern California, Los Angeles, California
| | - Shrikanth Narayanan
- Department of Electrical and Computer Engineering, University of Southern California, Los Angeles, California; Department of Otolaryngology-Head & Neck Surgery, University of Southern California, Los Angeles, California
| | - Michael M Johns
- Department of Otolaryngology-Head & Neck Surgery, University of Southern California, Los Angeles, California
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McGlashan J, Aaen M, White A, Sadolin C. A mixed-method feasibility study of the use of the Complete Vocal Technique (CVT), a pedagogic method to improve the voice and vocal function in singers and actors, in the treatment of patients with muscle tension dysphonia: a study protocol. Pilot Feasibility Stud 2023; 9:88. [PMID: 37226281 DOI: 10.1186/s40814-023-01317-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 05/02/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Muscle tension dysphonia (MTD) results from inefficient or ineffective voice production and is the cause of voice and throat complaints in up to 40% of patients presenting with hoarseness. Standard treatment is voice therapy (SLT-VT) delivered by specialist speech therapists in voice disorders (SLT-V). The Complete Vocal Technique (CVT) is a structured, pedagogic method which helps healthy singers and other performers optimise their vocal function enabling them to produce any sound required. The aim of this feasibility study is to investigate whether CVT administered by a trained, non-clinical CVT practitioner (CVT-P) can be applied to patients with MTD before progressing to a pilot randomised control study of CVT voice therapy (CVT-VT) versus SLT-VT. METHODS/DESIGN In this feasibility study, we use a mixed-method, single-arm, prospective cohort design. The primary aim is to demonstrate whether CVT-VT can improve the voice and vocal function in patients with MTD in a pilot study using multidimensional assessment methods. Secondary aims are to assess whether (1) a CVT-VT study is feasible to perform; (2) is acceptable to patients, the CVT-P and SLT-VTs; and (3) whether CVT-VT differs from existing SLT-VT techniques. A minimum of 10 consecutive patients with a clinical diagnosis of primary MTD (types I-III) will be recruited over a 6-month period. Up to 6 video sessions of CVT-VT will be delivered by a CVT-P using a video link. The primary outcome will be a change in pre-/post-therapy scores of a self-reported patient questionnaire (Voice Handicap Index (VHI)). Secondary outcomes include changes in throat symptoms (Vocal Tract Discomfort Scale), acoustic/electroglottographic and auditory-perceptual measures of voice. Acceptability of the CVT-VT will be assessed prospectively, concurrently and retrospectively both quantitatively and qualitatively. Differences from SLT-VT will be assessed by performing a deductive thematic analysis of CVT-P transcripts of therapy sessions. CONCLUSION This feasibility study will provide important data to support whether to proceed with a randomised controlled pilot study focusing on the effectiveness of the intervention compared to standard SLT-VT. Progression criteria will be based on demonstrating a positive outcome in treatment, successful delivery of the pilot study protocol, acceptability to all stakeholders and satisfactory recruitment rates. TRIAL REGISTRATION ClinicalTrials.gov website ( NCT05365126 Unique Protocol ID: 19ET004). Registered on 06 May 2022.
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Affiliation(s)
- Julian McGlashan
- Ear, Nose and Throat Department, Queen's Medical Centre Campus, Nottingham University Hospitals, Nottingham, NG7 2UH, UK.
| | - Mathias Aaen
- Complete Vocal Institute, Kompagnistraede 32A, 1208, Copenhagen K, Denmark
- Honorary Researcher, Ear, Nose and Throat Department, Queen's Medical Centre Campus, Nottingham University Hospitals, Nottingham, NG7 2UH, UK
| | - Anna White
- Ear, Nose and Throat Department, Queen's Medical Centre Campus, Nottingham University Hospitals, Nottingham, NG7 2UH, UK
| | - Cathrine Sadolin
- Complete Vocal Institute, Kompagnistraede 32A, 1208, Copenhagen K, Denmark
- Honorary Researcher, Ear, Nose and Throat Department, Queen's Medical Centre Campus, Nottingham University Hospitals, Nottingham, NG7 2UH, UK
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Saki N, Nasiri R, Bayat A, Nikakhlagh S, Salmanzadeh S, Khoramshahi H. Relationship Between Vocal Fatigue Index and Acoustic Voice Scales in Patients With Coronavirus Infection. J Voice 2023:S0892-1997(23)00152-2. [PMID: 37277295 DOI: 10.1016/j.jvoice.2023.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The voice quality of patients with Coronavirus Disease 2019 (COVID-19) seems to be affected due to lower and upper respiratory involvement. Patient-based voice assessment scales are important clinical measures to diagnose voice disorders and monitor treatment outcomes in COVID-19 patients. This study compared vocal fatigue between COVID-19 patients and those with normal voices. Furthermore, the relationship between vocal fatigue and acoustic voice parameters of COVID-19 patients was evaluated. METHODS This cross-sectional study enrolled 30 laboratory-confirmed patients with COVID-19 (18 males and 12 females) and 30 healthy individuals with normal voices (14 males and 16 females) to compare their respiratory or phonatory parameters. The Persian versions of the Consensus Auditory Perceptual Evaluation of Voice (CAPE-V) and the vocal fatigue index (VFI) were conducted before and after reading the text. The Jitter, shimmer, maximum phonation time, and harmonic-to-noise ratio (HNR) were analyzed by Praat software based on the recorded voices of CAPE-V tasks. The acoustic assessment and VFI questionnaire results were compared between COVID-19 patients and the control group. RESULTS There were significant differences between COVID-19 patients and their healthy counterparts in all VFI subscales (P < 0.001). Moreover, after reading the text, we found significant differences between the two groups regarding Jitter, shimmer, and HNR of /a/ and /i/ vowels (P < 0.05). Our findings also indicated a significant correlation between symptom improvement with rest and acoustic parameters in all tasks, except the Jitter of /a/ before reading the text. CONCLUSION Patients with COVID-19 showed significantly more vocal fatigue than people with normal voices after reading the text. Moreover, there was a significant relationship between Jitter, shimmer, and HNR and the tiredness of voice and physical discomfort subscales of VFI.
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Affiliation(s)
- Nader Saki
- Department of Otolaryngology, Head and Neck Surgery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Khuzestan Province, Iran; Hearing Research Center, Clinical Sciences Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Khuzestan Province, Iran
| | - Reyhane Nasiri
- Hearing Research Center, Clinical Sciences Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Khuzestan Province, Iran
| | - Arash Bayat
- Department of Audiology, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Khuzestan Province, Iran; Hearing Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Khuzestan Province, Iran
| | - Soheila Nikakhlagh
- Department of Otolaryngology, Head and Neck Surgery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Khuzestan Province, Iran
| | - Shokrollah Salmanzadeh
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Khuzestan Province, Iran
| | - Hassan Khoramshahi
- Mobility Impairment Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Mazandaran Province, Iran; Department of Speech Therapy, School of Rehabilitation, Babol University of Medical Sciences, Babol, Mazandaran Province, Iran.
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Fujiki RB, Thibeault SL. Examining Relationships Between GRBAS Ratings and Acoustic, Aerodynamic and Patient-Reported Voice Measures in Adults With Voice Disorders. J Voice 2023; 37:390-397. [PMID: 33750626 PMCID: PMC8419204 DOI: 10.1016/j.jvoice.2021.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/31/2021] [Accepted: 02/09/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine if auditory-perceptual voice ratings performed using the GRBAS scale correlate with acoustic and aerodynamic measures of voice. A secondary aim was to examine the relationship between GRBAS ratings and patient-reported quality of life scales. METHODS GRBAS ratings, acoustic, aerodynamic and patient-reported quality of life ratings were collected from the University of Wisconsin Madison Voice and Swallow Outcomes Database for 508 adults with voice disorders. Acoustic measures included noise to harmonic ratio, jitter%, shimmer%, highest fundamental frequency (F0) of vocal range, lowest F0 of vocal range, maximum phonation time and dysphonia severity index. Aerodynamic measures included phonation threshold pressure, subglottal pressure, mean transglottal airflow and laryngeal airway resistance. Patient-reported quality of life measures included the Vocal Handicap Index (VHI) and Glottal Function Index (GFI). RESULTS GRBAS ratings were significantly correlated with several acoustic and aerodynamic measures, VHI and GFI. The strongest significant correlations for acoustic measures were observed between GRBAS ratings of overall voice quality and perturbation measures (jitter% r = 0.58, shimmer% r = 0.45, noise to harmonic ratio r = 0.36, Dysphonia Severity Index r = -0.56). The strongest significant correlation for aerodynamic voice measures was observed between GRBAS ratings of breathiness and transglottal airflow (r = 0.23), subglottal pressure (r = 0.49), and phonation threshold pressure (r = 0.26). GRBAS ratings were also significantly correlated with both VHI and the GFI scales. R values were higher for the VHI, but remained largely in low range for both scales. CONCLUSIONS Although GRBAS ratings were significantly correlated with multiple objective voice and patient related quality of life ratings, r values were low. These findings support the need for multiple voice measures when performing voice evaluations as no single voice measure was highly correlated with voice quality as measured by the GRBAS scale.
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Affiliation(s)
- Robert Brinton Fujiki
- Department of Surgery, University of Wisconsin Madison, Wisconsin Institutes for Medical Research (WIMR) BLDG. 1485, Madison, Wisconsin
| | - Susan L Thibeault
- Department of Surgery, University of Wisconsin Madison, Wisconsin Institutes for Medical Research (WIMR) BLDG. 1485, Madison, Wisconsin.
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Awan SN, Shaikh MA, Awan JA, Abdalla I, Lim KO, Misono S. Smartphone Recordings are Comparable to "Gold Standard" Recordings for Acoustic Measurements of Voice. J Voice 2023:S0892-1997(23)00031-0. [PMID: 37019804 PMCID: PMC10545813 DOI: 10.1016/j.jvoice.2023.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 04/07/2023]
Abstract
PURPOSE The purpose of this study was to assess the relationship and comparability of cepstral and spectral measures of voice obtained from a high-cost "flat" microphone and precision sound level meter (SLM) vs. high-end and entry level models of commonly and currently used smartphones (iPhone i12 and iSE; Samsung s21 and s9 smartphones). Device comparisons were also conducted in different settings (sound-treated booth vs. typical "quiet" office room) and at different mouth-to-microphone distances (15 and 30 cm). METHODS The SLM and smartphone devices were used to record a series of speech and vowel samples from a prerecorded diverse set of 24 speakers representing a wide range of sex, age, fundamental frequency (F0), and voice quality types. Recordings were analyzed for the following measures: smoothed cepstral peak prominence (CPP in dB); the low vs high spectral ratio (L/H Ratio in dB); and the Cepstral Spectral Index of Dysphonia (CSID). RESULTS A strong device effect was observed for L/H Ratio (dB) in both vowel and sentence contexts and for CSID in the sentence context. In contrast, device had a weak effect on CPP (dB), regardless of context. Recording distance was observed to have a small-to-moderate effect on measures of CPP and CSID but had a negligible effect on L/H Ratio. With the exception of L/H Ratio in the vowel context, setting was observed to have a strong effect on all three measures. While these aforementioned effects resulted in significant differences between measures obtained with SLM vs. smartphone devices, the intercorrelations of the measurements were extremely strong (r's > 0.90), indicating that all devices were able to capture the range of voice characteristics represented in the voice sample corpus. Regression modeling showed that acoustic measurements obtained from smartphone recordings could be successfully converted to comparable measurements obtained by a "gold standard" (precision SLM recordings conducted in a sound-treated booth at 15 cm) with small degrees of error. CONCLUSIONS These findings indicate that a variety of commonly available modern smartphones can be used to collect high quality voice recordings usable for informative acoustic analysis. While device, setting, and distance can have significant effects on acoustic measurements, these effects are predictable and can be accounted for using regression modeling.
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Affiliation(s)
- Shaheen N Awan
- University of South Florida, Dept. of Communication Sciences & Disorders, Tampa FL 33620.
| | - Mohsin Ahmed Shaikh
- Commonwealth University of Pennsylvania, Dept. of Communication Sciences & Disorders, Bloomsburg PA 17815
| | - Jordan A Awan
- Purdue University, Dept. of Statistics, Mathematical Sciences Building, 150 N. University Street, West Lafayette, IN 47907
| | - Ibrahim Abdalla
- University of Minnesota Medical School, 420 Delaware Street SE, Minneapolis, MN 55455
| | - Kelvin O Lim
- University of Minnesota Medical School, Dept. of Psychiatry and Behavioral Sciences, 420 Delaware Street SE, Minneapolis, MN 55455
| | - Stephanie Misono
- University of Minnesota Medical School, Division of Laryngology, Department of Otolaryngology, Head and Neck Surgery, 420 Delaware Street SE, Minneapolis, MN 55455
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Zhang J, Liss J, Jayasuriya S, Berisha V. Robust Vocal Quality Feature Embeddings for Dysphonic Voice Detection. IEEE/ACM TRANSACTIONS ON AUDIO, SPEECH, AND LANGUAGE PROCESSING 2023; 31:1348-1359. [PMID: 37899766 PMCID: PMC10602198 DOI: 10.1109/taslp.2023.3261753] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Approximately 1.2% of the world's population has impaired voice production. As a result, automatic dysphonic voice detection has attracted considerable academic and clinical interest. However, existing methods for automated voice assessment often fail to generalize outside the training conditions or to other related applications. In this paper, we propose a deep learning framework for generating acoustic feature embeddings sensitive to vocal quality and robust across different corpora. A contrastive loss is combined with a classification loss to train our deep learning model jointly. Data warping methods are used on input voice samples to improve the robustness of our method. Empirical results demonstrate that our method not only achieves high in-corpus and cross-corpus classification accuracy but also generates good embeddings sensitive to voice quality and robust across different corpora. We also compare our results against three baseline methods on clean and three variations of deteriorated in-corpus and cross-corpus datasets and demonstrate that the proposed model consistently outperforms the baseline methods.
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Affiliation(s)
- Jianwei Zhang
- School of Electrical, Computer and Energy Engineering, Arizona State University, Tempe, AZ 85281, USA
| | - Julie Liss
- College of Health Solutions, Arizona State University, Tempe, AZ 85287, USA
| | - Suren Jayasuriya
- School of Arts, Media and Engineering and the School of Electrical, Computer and Energy Engineering at Arizona State University, Tempe, AZ 85281, USA
| | - Visar Berisha
- College of Health Solutions and School of Electrical, Computer and Energy Engineering, Arizona State University, Tempe, AZ 85281, USA
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Park Y, Anand S, Gifford SM, Shrivastav R, Eddins DA. Development and Validation of a Single-Variable Comparison Stimulus for Matching Strained Voice Quality Using a Psychoacoustic Framework. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:16-29. [PMID: 36516473 PMCID: PMC10023177 DOI: 10.1044/2022_jslhr-22-00280] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/17/2022] [Accepted: 09/01/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE Acoustic and perceptual quantification of vocal strain has been a vexing problem for years. To increase measurement rigor, a suitable single-variable matching stimulus for strain was developed and validated, based on the matching stimulus used previously for breathy and rough voice qualities. METHOD A set of 21 comparison stimuli for a single-variable matching task (SVMT) was synthesized based on a speech-shaped sawtooth waveform mixed with speech-shaped noise. Variable bandpass filter gain in mid-to-high frequencies achieved a wide range of computed sharpness (in constant sharpness steps) and served as the independent variable for the SVMT. Ten natural /ɑ/ stimuli with a wide range of the primary voice quality of strain and a minimum of breathiness or roughness were selected and assessed using the SVMT. Natural voice samples and synthetic comparison stimuli were also assessed using a perceptual magnitude estimation (ME) task. RESULTS ME data validated the correspondence of the set of comparison stimuli to varying perceived strain. Perceived strain magnitudes of the comparison stimuli increased significantly and linearly with computed sharpness (r 2 = .99). A linear regression revealed that strain matching values were significantly predicted by computed sharpness (r 2 = .96) and perceived strain magnitudes (r 2 = .95) of the natural voice stimuli. CONCLUSION The perception of vocal strain is strongly associated with computed sharpness and is captured accurately and precisely using an SVMT, in which the independent variable is the bandpass filter gain (in steps of equal sharpness) applied to the comparison stimuli.
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Affiliation(s)
- Yeonggwang Park
- Department of Communication Sciences & Disorders, University of South Florida, Tampa
| | - Supraja Anand
- Department of Communication Sciences & Disorders, University of South Florida, Tampa
| | - Sophia M. Gifford
- Department of Communication Sciences & Disorders, University of South Florida, Tampa
| | - Rahul Shrivastav
- Office of the Provost & Executive Vice President, Indiana University, Bloomington
| | - David A. Eddins
- Department of Communication Sciences & Disorders, University of South Florida, Tampa
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Yunusova Y, Waito A, Barnett Tapia C, Huynh A, Martino R, Abrahao A, Pattee GL, Berry JD, Zinman L, Green JR. Face and content validation of the amyotrophic lateral sclerosis-Bulbar dysfunction index (ALS-BDI). Front Neurol 2023; 13:1078612. [PMID: 36686519 PMCID: PMC9849694 DOI: 10.3389/fneur.2022.1078612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/08/2022] [Indexed: 01/06/2023] Open
Abstract
Purpose Early detection and tracking of bulbar dysfunction in amyotrophic lateral sclerosis (ALS) are critical for directing management of the disease. Existing physiological assessments of bulbar dysfunction are often inaccessible and cost-prohibitive for clinical application. Existing clinical assessments are limited. The overall goal of our research is to develop a brief and reliable, clinician-administered assessment tool, the ALS Bulbar Dysfunction Index (ALS-BDI) to evaluate bulbar dysfunction. The aim of this study was to establish content and face validity of the ALS-BDI through item generation and reduction, including item scoring. Methods The design of the ALS-BDI followed guidelines outlined by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). The design stage of the ALS-BDI involved two steps: (Step 1) the generation of candidate items from a literature review of commonly used clinical tools, and selection of items following a review of item reliability and item relevance and expert consensus; (Step 2) the assessment of their content and face validity via online survey feedback from experts (n = 35). The initial design was followed by a semi-structured cognitive interview with Speech-Language Pathologists (n = 5) to finalize a testable draft of the instrument. Results Two drafts of the ALS-BDI were developed. The first draft contained 48 items, after a review of existing clinical tools for their relevance to bulbar dysfunction in ALS. Of the 48 items, 35 items were retained after surveying experts and clinician users for their relevance, feasibility, interpretability, and appropriateness. The second draft of the ALS-BDI contained 37 items, due to one item splitting, based on users cognitive interviews. Conclusions The ALS-BDI described in this study aims to provide a brief and reliable, clinician-administered assessment tool to evaluate bulbar dysfunction in patients with ALS. Future research will evaluate the psychometric properties of this tool including its reliability, validity, and responsiveness to change over time.
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Affiliation(s)
- Yana Yunusova
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada,Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada,KITE – University Health Network, Toronto, ON, Canada,*Correspondence: Yana Yunusova ✉
| | - Ashley Waito
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Carolina Barnett Tapia
- Division of Neurology, Department of Medicine, University of Toronto and University Health Network, Toronto, ON, Canada,Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Anna Huynh
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada,Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada,KITE – University Health Network, Toronto, ON, Canada
| | - Rosemary Martino
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada,Department of Otolaryngology – Head and Neck Surgery, University of Toronto, Toronto, ON, Canada,Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Agessandro Abrahao
- Division of Neurology, Department of Medicine, University of Toronto and University Health Network, Toronto, ON, Canada,Department of Medicine, Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - James D. Berry
- Sean M. Healey and AMG Center for ALS, Massachusetts General Hospital, Boston, MA, United States
| | - Lorne Zinman
- Division of Neurology, Department of Medicine, University of Toronto and University Health Network, Toronto, ON, Canada,Department of Medicine, Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Jordan R. Green
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA, United States,Speech and Hearing Bioscience and Technology, Harvard University, Boston, MA, United States
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Rangarathnam B, Paramby T, McCullough GH, Pickett H, Tulunay-Ugur ÖE, Zraick RI. A randomized controlled trial of the effects of flow phonation voice treatment for primary muscle tension dysphonia. JOURNAL OF COMMUNICATION DISORDERS 2023; 101:106290. [PMID: 36502668 PMCID: PMC9905289 DOI: 10.1016/j.jcomdis.2022.106290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 11/13/2022] [Accepted: 11/27/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE The purpose of the study was to investigate the effects of flow phonation voice therapy on laryngeal physiology and vocal quality in persons with primary Muscle Tension Dysphonia (MTD1). METHODS Seventeen participants with a diagnosis of MTD1 completed the study. Participants were randomized to two groups. Group 1 (9 participants) received flow phonation treatment and individualized vocal hygiene education for 12 sessions over six weeks. Group 2 (8 participants) received vocal hygiene education only for three weeks (6 sessions), followed by another three weeks (6 sessions) of both vocal hygiene instruction and flow phonation therapy. Treatment consisted of cup-bubble blowing, gargling, and stretch and flow exercises. Visual-perceptual. auditory-perceptual, acoustic, aerodynamic and voice-related quality-of-life measures were obtained at three time points: before treatment, three weeks after initiation of treatment and after completion of treatment. RESULTS Voice quality was perceived to be significantly improved in both groups. Voice related quality-of-life trended toward improvement for both groups across time points. Changes in aerodynamic and acoustic measures did not reach statistical significance compared to baseline for both groups. Visual comparisons of laryngeal closure patterns demonstrated comparably better outcomes for Group 1. CONCLUSIONS Results of this study indicate flow phonation exercises can potentially be favorably employed for individuals with MTD1. In particular, it appears that the exercises aid in alleviating vocal hyperfunction, as evidenced by visual perceptual stroboscopic analysis, and clinically improved auditory-perceptual measures.
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Affiliation(s)
- Balaji Rangarathnam
- Department of Speech Language Pathology, Midwestern University, United States.
| | - Towino Paramby
- Department of Communication Sciences and Disorders, University of Central Arkansas, United States; Department of University Rehabilitation, UAMS Medical Center, United States
| | - Gary H McCullough
- College of Health Sciences, Appalachian State University, United States
| | - Hylan Pickett
- Department of University Rehabilitation, UAMS Medical Center, United States
| | - Özlem E Tulunay-Ugur
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, United States
| | - Richard I Zraick
- School of Communication Sciences and Disorders, University of Central Florida, United States
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Vincent I, Emm MJ. The Effects of Collegiate Sports Coaching on the Male Voice: Pilot Data. J Voice 2023; 37:145.e7-145.e18. [PMID: 33376021 DOI: 10.1016/j.jvoice.2020.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 01/11/2023]
Abstract
PURPOSE This research gathered pilot data on the effects of a typical collegiate athletic season on the male coach's voice. MATERIALS AND METHODS Ten male coaches and ten age- and sex-matched controls participated. Qualitative and quantitative analyses were performed to assess group differences in: 1) written self-reports obtained during one session, 2) acoustic and aerodynamic variables obtained during regular season and during off-season for the coaches and only once for the controls, and 3) auditory-perceptual data provided by three speech-language pathologists using the Consensus Auditory-Perceptual Evaluation of Voice during one listening session. Data pertaining to the coaches' regular season, to the coaches' off-season, and to the control participants were designated as in-season, off-season, and control, respectively. RESULTS Significant self-reported findings included more phonotraumatic behaviors in the coaches than in the controls and higher in-season than off-season and control vocal demand. The coaches' history of voice problems was unrelated and the controls' was related to respiratory illness and addressing a large audience. A significant acoustic finding was lower off-season than control low fundamental frequency. Finally, trained listeners perceived control loudness as more aberrant than off-season loudness and they noted vocal fry twice as many times in in-season and off-season than in control voices. CONCLUSIONS This study exposed traces of adverse voice reactions to coaching and confirmed that coaches harbor a job-based proclivity to voice overuse. Self-reported measures appeared to be the least and aerodynamic the most immune to phonatory exertion that pervades daily coaching tasks. Future studies are warranted to further delineate how athletic coaching interferes with voice production.
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Affiliation(s)
- Irena Vincent
- State University of New York College at Cortland, Communication Disorders and Sciences Department, Cortland, NY.
| | - Mary J Emm
- State University of New York College at Cortland, Communication Disorders and Sciences Department, Cortland, NY.
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Nagle KF. Clinical Use of the CAPE-V Scales: Agreement, Reliability and Notes on Voice Quality. J Voice 2022:S0892-1997(22)00366-6. [PMID: 36543606 DOI: 10.1016/j.jvoice.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The CAPE-V is a widely used protocol developed to help standardize the evaluation of voice. Variability of voice quality ratings has prevented development of training protocols that might themselves improve interrater agreement among new clinicians. As part of a larger mixed methods project, this study examines agreement and reliability for experienced clinicians using the CAPE-V scales. STUDY DESIGN Observational. METHODS Experienced voice clinicians (N=20) provided ratings of recordings from 12 speakers representing a range of overall voice quality. Participants were instructed to rate the voices as they normally would, using the CAPE-V scales. Descriptive data were recorded and two levels of agreement were calculated. Single rater reliability was calculated using a 2-way random model of absolute agreement for intraclass correlations (ICC [2,1]). RESULTS Participants use of the CAPE-V scales varied considerably, although most rated overall severity, breathiness, roughness and strain. Data from one participant did not meet a priori agreement criteria. Because outcomes were significantly different without their data, agreement and reliability were analyzed based on the reduced data set from 19 participants. Interrater agreement and reliability were comparable to previous research; the mean range of ratings was at least 47mm for all dimensions of voice quality. CONCLUSIONS Results indicated differential use of the components of the CAPE-V form and scales in evaluating voice quality and severity of dysphonia, including categorical variability among ratings of all of the primary CAPE-V dimensions of voice quality that may complicate the clinical description of a voice as mildly, moderately or severely dysphonic.
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Affiliation(s)
- Kathleen F Nagle
- Department of Speech-Language Pathology, School of Health & Medical Science, Seton Hall University, Nutley, New Jersey.
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Venkatraman Y, Mahalingam S, Boominathan P. Development and Validation of Sentences in Tamil for Psychoacoustic Evaluation of Voice Using the Consensus Auditory-Perceptual Evaluation of Voice. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:4539-4556. [PMID: 36368051 DOI: 10.1044/2022_jslhr-22-00169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE The Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) is a standardized instrument used in voice assessment to assess voice quality. It has been translated and culturally adapted in several languages. This study aimed at developing and validating a Tamil version of CAPE-V through auditory perceptual evaluation of remotely recorded voice samples. METHOD The Tamil version was adapted with permission from the American Speech-Language-Hearing Association to match the rationale in English CAPE-V. The sentences were constructed by the first author and validated for content by two panels of experts. Forty-five participants (15 cases and 30 controls) were included in the study. Data recording was conducted online (Zoom Video Communications, Inc., app) for all samples. Three raters participated in the auditory evaluation and scored all samples using Grade, Roughness, Breathiness, Asthenia, and Strain (GRBAS) scale followed by CAPE-V with a week gap in between. Twenty percent of samples were repeated to assess intrarater reliability. The intrarater and interrater reliability measures for Tamil CAPE-V were established using intraclass coefficients (ICCs). To ensure construct validity, group differences were determined between the cases and controls. The concurrent validity was established by correlating Tamil CAPE-V with the GRBAS scale. RESULTS The intrarater reliability for Tamil CAPE-V ranged from moderate to excellent (ICC: .610-.998). The Tamil CAPE-V obtained moderate to good interrater reliability for all parameters (ICC: .525-.790) except pitch (ICC: .405). The differences between the cases and controls were statistically significant (p < .01). The correlation between CAPE-V and GRBAS was strong for overall severity, breathiness, and strain (r s = .725-.861) and moderate for roughness (r s = .678). CONCLUSION The Tamil CAPE-V is a reliable and valid tool for auditory perceptual evaluation in Tamil-speaking populations. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21513885.
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Affiliation(s)
- Yamini Venkatraman
- Department of Speech, Language and Hearing Sciences, Sri Ramachandra Faculty of Audiology & Speech Language Pathology, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Chennai, India
| | - Shenbagavalli Mahalingam
- Department of Speech, Language and Hearing Sciences, Sri Ramachandra Faculty of Audiology & Speech Language Pathology, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Chennai, India
| | - Prakash Boominathan
- Department of Speech, Language and Hearing Sciences, Sri Ramachandra Faculty of Audiology & Speech Language Pathology, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Chennai, India
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Aghadoost S, Molazeinal Y, Khoddami SM, Shokuhifar G, Dabirmoghaddam P, Saffari M. Dysphonia Severity Index and Consensus Auditory-Perceptual Evaluation of Voice Outcomes, and Their Relation in Hospitalized Patients with COVID-19. J Voice 2022:S0892-1997(22)00384-8. [PMID: 36642593 PMCID: PMC9712076 DOI: 10.1016/j.jvoice.2022.11.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/24/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVES This study aimed to compare the results of the Dysphonia Severity Index (DSI) and Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) between patients hospitalized with COVID-19 and healthy subjects, as well as to investigate the correlation between DSI and CAPE-V. STUDY DESIGN Cross-sectional survey. MATERIAL AND METHODS Eighty subjects, 40 COVID-19 patients (with a mean age of 41.2± 5.41) and 40 healthy subjects (with a mean age of 44.50± 3.50) participated in this study. Assessments included the DSI for aerodynamic-acoustic measurement and the Persian version of Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) for evaluating auditory-perceptual voice quality. Data were analyzed by means of the independent t-test and Pearson correlation at the 5% significance level. RESULTS The results showed COVID-19 patients got significantly lower score in DSI compared to healthy subjects (P < 0.05). Moreover, the patients with COVID-19 had higher scores in all categories of voice production (severity, roughness, loudness, pitch, strain and breathiness) than the healthy group (P < 0.05). Comparing the result of the two voice assessments in each group revealed that there was a greater negative significant correlation in the diseased group (r p: -0.68, P: 0.001) than in the healthy group (r p: -0.37,P: 0.049). CONCLUSIONS Hospitalized COVID-19 patients experience deviations in the voice quality and acoustic-aerodynamic features of their voice. Also, the results of this study showed the patient group had higher perceptual dysphonia and lower voice quality compared to the healthy group. Further studies are recommended to determine the relationship between objective and subjective voice evaluation in patients with COVID-19 after recovery.
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Affiliation(s)
- Samira Aghadoost
- Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Tehran, Iran.
| | - Yasamin Molazeinal
- School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Tehran, Iran
| | - Seyyedeh Maryam Khoddami
- Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Tehran, Iran
| | - Ghazaal Shokuhifar
- Department of audiology, University of Social Welfare and Rehabilitation, Tehran, Tehran, Iran
| | - Payman Dabirmoghaddam
- Otolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Tehran, Iran
| | - Maryam Saffari
- Department of radiology, faculty of medicine, Kashan University of Medical Sciences, Tehran, Tehran, Iran
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Park Y, Anand S, Kopf LM, Shrivastav R, Eddins DA. Interactions Between Breathy and Rough Voice Qualities and Their Contributions to Overall Dysphonia Severity. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:4071-4084. [PMID: 36260821 PMCID: PMC9940885 DOI: 10.1044/2022_jslhr-22-00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE Dysphonic voices typically present multiple voice quality dimensions. This study investigated potential interactions between perceived breathiness and roughness and their contributions to overall dysphonia severity. METHOD Synthetic stimuli based on four talkers were created to systematically map out potential interactions. For each talker, a stimulus matrix composed of 49 stimuli (seven breathiness steps × seven roughness steps) was created by varying aspiration noise and open quotient to manipulate breathiness and superimposing amplitude modulation of varying depths to simulate roughness. One-dimensional matching (1DMA) and magnitude estimation (1DME) tasks were used to measure perceived breathiness, roughness, their potential interactions, and overall dysphonia severity. Additional 1DME tasks were used to assess a set of natural stimuli that varied along both breathiness and roughness. RESULTS For the synthetic stimuli, the 1DMA task indicated little interaction between the two voice qualities. For the 1DME task, breathiness magnitude was influenced by roughness step to a greater extent than roughness magnitude was influenced by breathiness step. The additive contributions of breathiness and roughness to overall severity gradually diminished with increasing breathiness and roughness steps, possibly reflecting a ceiling effect in the 1DME task. For the natural stimuli, little consistent interaction was observed between breathiness and roughness. CONCLUSIONS The matching task revealed minimal interaction between perceived breathiness and roughness, whereas the magnitude estimation task revealed some interaction between the two qualities and their cumulative contributions to overall dysphonia severity. Task differences are discussed in terms of differences in response bias and the role of perceptual anchors. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21313701.
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Affiliation(s)
- Yeonggwang Park
- Department of Communication Sciences and Disorders, University of South Florida, Tampa
| | - Supraja Anand
- Department of Communication Sciences and Disorders, University of South Florida, Tampa
| | - Lisa M. Kopf
- Department of Speech, Language and Hearing Sciences, The George Washington University, Washington, DC
| | - Rahul Shrivastav
- Office of the Provost and Executive Vice President, Indiana University, Bloomington
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing
| | - David A. Eddins
- Department of Communication Sciences and Disorders, University of South Florida, Tampa
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing
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Dabirmoghaddam P, Khoramshahi H, Dehqan A, Scherer RC, Ansari NN. Construct and Discriminant Validity of the Persian Version of the Consensus Auditory Perceptual Evaluation of Voice (CAPE-V). J Voice 2022; 36:876.e9-876.e15. [PMID: 33036831 DOI: 10.1016/j.jvoice.2020.09.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 09/24/2020] [Accepted: 09/25/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE Five dimensions of voice assessment are considered as visual evaluation, videostroboscopy, acoustic, aerodynamic, patient-based, and auditory-perceptual. Auditory-perceptual voice assessment scales are the standard scales for clinicians to document voice therapy outcomes in dysphonic patients. The primary objective of the present study was to investigate the construct and discriminant validities of the Persian Version of the CAPE-V (ATSHA). A secondary objective was to determine the differences between experienced and inexperienced raters in the auditory-perceptual assessment of voice. METHOD Forty normal and forty individuals with dysphonia were rated by five experienced and five inexperienced raters. Pathological subgroups were vocal fold nodules, vocal fold polyps, unilateral vocal fold paralysis (UVFP), and Reinke's edema. The differences between normal and pathologic groups were observed by independent t tests for all perceptual parameters (P < 0.05). Construct validity was documented for the scale of interest. The Kruskal-Wallis and Mann-Whitney comparisons were used to examine discriminant validity. RESULTS Findings of these tests showed that scores of all pathological subgroups were significantly different except for the parameter of "strain" in sustained vowels (P < 0.05). Results of the Wilcoxon Matched-Pairs Signed Rank Test indicated that experienced and inexperienced raters were significantly different in auditory-perceptual judgments of voice. CONCLUSION It seems that the Persian Version of the CAPE-V is a consistent predictor of normal and pathological voices. Moreover, we found that experienced listeners have different auditory-perceptual skills in evaluation of voice that make them more precise than inexperienced listeners.
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Affiliation(s)
- Payman Dabirmoghaddam
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hassan Khoramshahi
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ali Dehqan
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Ronald C Scherer
- Distinguish Research Professor, Department of Communication Sciences and Disorders, Bowling Green State University, Bowling Green, Ohio
| | - Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
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Vahid M, Mansuri B, Farzadi F, Tohidast SA, Bagheri R, Scherer RC. Immediate Effects of Combining Kinesio Tape with Voice Therapy in Patients with Muscle Tension Dysphonia. J Voice 2022:S0892-1997(22)00278-8. [PMID: 36283906 DOI: 10.1016/j.jvoice.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 09/03/2022] [Accepted: 09/06/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The present study investigated the immediate effect of adding Kinesio taping along with voice therapy for the treatment of muscle tension dysphonia patients. MATERIALS AND METHODS Twenty patients with primary muscle tension dysphonia (MTD) (12 males and 8 females) with a mean age of 36.95 ± 9.58 years participated in the study. Participants were assigned to two groups: one group (6 males and 4 females) received only traditional voice therapy (VT) and the other group (6 males and 4 females) received Kinesio taping (KT) and voice therapy (VT). The VT group received laryngeal manual therapy (LMT) (for 15 minutes) and voice therapy techniques including humming, chewing, and yawn-sigh (for 15 minutes). The VT + KT group received both KT and the same VT as the first group. KT was applied to the sternocleidomastoid, infralaryngeal, and supralaryngeal muscles of the neck. Auditory-perceptual assessments using CAPE-V, acoustic voice analysis, and assessments of vocal tract discomfort and pain were used to evaluate the effects of a single treatment session. The Wilcoxon and Mann-Whitney U tests were used for data analysis. RESULTS The results of within-group comparison of the auditory-perceptual assessment (overall severity, roughness, breathiness, and strain) in both sustained vowels and connected speech tasks showed a significant reduction in all mentioned items in both groups (P < 0.05). Acoustic voice analysis showed significant improvement of HNR in the KT + VT group for both sustained vowels and connected speech tasks, and significant improvement of jitter in the VT group for sustained vowels (P < 0.05). Regarding vocal tract discomfort, the symptom of tightness in the KT + VT group, irritability and pain in the VT group, and the overall score of vocal tract discomfort in both groups, significantly decreased (P < 0.05). A significant decrease in pain severity in the front of the neck, throat, and larynx was reported by MTD patients in both groups (P < 0.05). Between-group comparisons indicated a significant difference only in the pain item of the VTD scale (P < 0.05) with greater pain decrease for the VT group. Comparison of the mean of differences showed that the VT group reduced irritability more than the KT + VT group (P < 0.05). CONCLUSION The present study showed that voice therapy with and without Kinesio taping can improve patients' voice quality (auditory-perceptual and acoustic voice analysis) and reduce vocal tract discomfort and pain in MTD patients after one therapy session. Moreover, MTD patients treated with KT + VT did not experience more significant improvements compared to those treated with VT alone. More studies in this area are recommended to better determine the effects of KT in MTD patients especially for long term effects of KT.
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Affiliation(s)
- Maedeh Vahid
- Department of Speech Therapy, School of Rehabilitation, Semnan University of Medical Sciences, Semnan, Iran
| | - Banafshe Mansuri
- Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran.
| | - Faezeh Farzadi
- Otorhinolaryngology Research Center, Amir A'lam Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Seyed Abolfazl Tohidast
- Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Rasool Bagheri
- Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Ronald Callaway Scherer
- Department of Communication Sciences and Disorders, Bowling Green State University, Bowling Green, Ohio
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Steiner SM, Slavych BK, Zraick RI. Assessment of Online Patient Education Material About Dysphagia. Dysphagia 2022; 38:990-1000. [PMID: 36205800 DOI: 10.1007/s00455-022-10524-3] [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: 06/08/2022] [Accepted: 09/11/2022] [Indexed: 11/26/2022]
Abstract
To examine quality, readability, understandability, and actionability of English-language online educational materials about dysphagia. A Google search of "dysphagia" and related terms was conducted. Web page quality and accountability were measured using HON and URAC certification seals, the DISCERN instrument, and JAMA benchmark criteria. Understandability and actionability were assessed with the Patient Education Materials Assessment Tool for Printed Material (PEMAT-P). Readability was assessed using the Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (F-KGL), Gunning Fog (FOG), and the Simple Measure of Gobbledygook (SMOG) scores using dedicated readability software. Fifty web pages were analyzed. Seventeen web pages displayed a HON or URAC seal. DISCERN scores ranged from 17 to 50 (Mdn = 25.00; IQR = 32.25-21.00). Of the JAMA benchmark criteria, 88% of web pages met the disclosure criterion, while only 22% met the authorship, 20% met the attribution, and 16% met the currency criteria. PEMAT-P understandability and actionability scores were 69.38% ± 11.14% and 28.58% ± 22.19%, respectively. Readability scores, on average, exceeded the recommended grade reading levels for health information (FRE 46.34 ± 13.59, F-KGL 10.26 ± 2.29, FOG 12.11 ± 2.08, and SMOG 12.38 ± 1.70). Online materials about dysphagia can be improved by obtaining quality certificates and by including content that is more readable and easier to understand and act upon.
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Affiliation(s)
- Sarah M Steiner
- University of Central Florida, 4364 Scorpius St., Suite 101, Orlando, FL, 32816, USA
| | - Bonnie K Slavych
- University of Central Missouri, 415 E. Clark St, Warrensburg, MO, 64093, USA.
- Missouri State University, 901 S. National Ave, Springfield, MO, 65897, USA.
| | - Richard I Zraick
- University of Central Florida, 4364 Scorpius St., Suite 101, Orlando, FL, 32816, USA
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46
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Ricci-Maccarini A, Schindler A, Mozzanica F, Fantini M, Murry T, Dejonckere P. Validity, Reliability and Reproducibility of the “Extended GRBAS Scale,” A Comprehensive Perceptual Evaluation of Dysphonia. J Voice 2022. [DOI: 10.1016/j.jvoice.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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47
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Baertsch HC, Bhatt NK, Giliberto JP, Dixon C, Merati AL, Sauder C. Quantification of Vocal Fold Atrophy in Age‐Related and Parkinson's Disease‐Related Vocal Atrophy. Laryngoscope 2022; 133:1462-1469. [PMID: 36111826 DOI: 10.1002/lary.30394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/07/2022] [Accepted: 08/18/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Vocal fold atrophy (VFA) is associated with aging and Parkinson's disease (PD). Clinical diagnosis of VFA depends on several visual-perceptual laryngostroboscopy findings that are inherently subjective. The purpose of this study was to use quantitative measurements to; (1) examine the relationships between VFA and dysphonia severity and (2) evaluate differences in VFA in patients with age-related VFA versus PD. METHODS Thirty-six patients >60 years of age with VFA were included in this retrospective cohort study. Demographic information, medical history, Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V), Voice Handicap Index-10 (VHI-10), and still images from the stroboscopic exam were obtained. Image J™ was used to measure VFA, including bowing index (BI), normalized glottal gap area, and normalized mucosal wave amplitude. Pearson's correlation was used to evaluate the relationship between VFA, CAPE-V, and VHI-10. t-Tests and multivariate linear regression were used to compare VFA measures by dysphonia severity (CAPE-V <30 vs. >30) and diagnosis (age-related vocal atrophy [ARVA] and PD). RESULTS BI was positively correlated with CAPE-V. Patients with CAPE-V >30 had a significantly larger BI compared to those with CAPE-V <30. Patients with PD had significantly larger BI than those with ARVA. Diagnosis of PD also predicted a larger BI after controlling for age and CAPE-V. CONCLUSION Quantitative measures supported an association between bowing severity and dysphonia severity in patients with PD and ARVA. A PD diagnosis significantly predicted more severe BI. These findings demonstrate the potential utility of BI. Quantitative VFA measures might also provide insight into the mechanisms of ARVA and dysphonia. LEVEL OF EVIDENCE 3 Laryngoscope, 133:1462-1469, 2023.
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Affiliation(s)
- Hans C. Baertsch
- Keck School of Medicine University of Southern California Los Angeles California U.S.A
| | - Neel K. Bhatt
- Division of Laryngology, Department Otolaryngology Head and Neck Surgery University of Washington Seattle Washington U.S.A
| | - John P. Giliberto
- Division of Laryngology, Department Otolaryngology Head and Neck Surgery University of Washington Seattle Washington U.S.A
| | - Connor Dixon
- Elson S Floyd College of Medicine Washington State University Spokane Washington U.S.A
| | - Albert L. Merati
- Division of Laryngology, Department Otolaryngology Head and Neck Surgery University of Washington Seattle Washington U.S.A
| | - Cara Sauder
- Division of Laryngology, Department Otolaryngology Head and Neck Surgery University of Washington Seattle Washington U.S.A
- Speech and Hearing Sciences University of Washington Seattle Washington U.S.A
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48
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Walden PR, Rau S. Individual Voice Dimensions' Prediction of Overall Dysphonia Severity on Two Auditory-Perceptual Scales. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:2759-2777. [PMID: 35868295 DOI: 10.1044/2022_jslhr-21-00689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Auditory-perceptual evaluation of dysphonic voice is an essential clinical activity that characterizes the nature of dysphonia and aids in planning its clinical management. Although there are multidimensional acoustic measures that correlate well with overall severity ratings, they tend to include measures that have only small or moderate correlations with individual voice characteristics frequently perceptually measured (e.g., breathiness or roughness). Given this difference between perceptual and acoustic measures, it is unclear how much individual voice characteristics contribute to a listener's perception of overall severity of dysphonia. PURPOSE The purpose of this study was to explore individual voice characteristics' relative contribution to the rating of overall dysphonia severity and to explore sex-related differences. METHOD Two hundred ninety-six voice samples were accessed from the Perceptual Voice Qualities Database. Roughness, breathiness, asthenia, strain, pitch, and loudness ratings from the Grade, Roughness, Breathiness, Asthenia, Strain and Consensus Auditory-Perceptual Evaluation of Voice scales were used to predict overall voice quality severity in linear regression with bootstrapped coefficients. RESULTS Roughness, breathiness, and strain were the strongest predictors of overall severity. Asthenia and, to a lesser extent, pitch were also significant predictors of overall severity. Loudness was not a significant predictor. There were several sex-related differences noted, as well as differences related to the scale used. CONCLUSIONS Breathiness, roughness, and strain were all important predictors of overall severity for all regressions. Clinicians should be aware of scale-related differences if they are using auditory-perceptual measures to choose voice therapy targets. Analyses accounting for perceptual strategy differences were recommended for future studies.
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Affiliation(s)
| | - Sydney Rau
- Department of Communication Sciences and Disorders, St. John's University, Queens, NY
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49
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Mohd Mossadeq N, Mohd Khairuddin KA, Zakaria MN. Cross-cultural Adaptation of the Consensus Auditory-perceptual Evaluation of Voice (CAPE-V) Into Malay: A Validity Study. J Voice 2022:S0892-1997(22)00151-5. [PMID: 35760635 DOI: 10.1016/j.jvoice.2022.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/25/2022] [Accepted: 05/25/2022] [Indexed: 10/17/2022]
Abstract
Auditory-perceptual rating of voice is one component of voice evaluation, and the CAPE-V is one of the tools for this purpose. Because of its advantages, the CAPE-V has been adapted into several languages. Accordingly, the adaptation of the CAPE-V into Malay is essential for its utility among the Malaysian population, which this study aimed to accomplish. This study involved translating the CAPE-V into Malay, termed the Malay CAPE-V, followed by establishing its validity. The translation processes (ie, forward translation and backward translation) involved four different translators ie, three speech-language therapists (SLTs), and one linguist with at least 14 years of experience. Most items were similarly translated, except for a few, which were subsequently accepted as similar, following consensus among the translators. In the examination of content validity, two raters (ie, SLTs) with at least 12 years of clinical experience reviewed and scored the tested items. Given that the scale-level content validity index average value (S-CVI/Ave) was above the acceptable level, all items were retained. The examination of construct validity and concurrent validity involved ratings of voice samples recorded from 38 participants, comprising 19 individuals with normal and disordered voices, respectively. The ratings were performed by three raters (ie, SLTs) with at least 12 years of clinical experience. For the construct validity, the Mann-Whitney U test indicated significantly higher scores of the vocal parameters of the Malay CAPE-V for the disordered voice group than for the normal voice group. Meanwhile, for the concurrent validity, the Spearman correlation indicated that all relationships between the scores of the vocal parameters of the Malay CAPE-V and GRBAS Scale were significant, with most of them achieving a very strong positive correlation. The results demonstrated that the Malay CAPE-V is a valid tool for an auditory-perceptual rating of voice among the Malaysian population.
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Affiliation(s)
- Nurhayati Mohd Mossadeq
- Speech Pathology Program, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia; Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Khairy Anuar Mohd Khairuddin
- Speech Pathology Program, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.
| | - Mohd Normani Zakaria
- Speech Pathology Program, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
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50
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Hseu AF, Spencer GP, Jo S, Clark R, Nuss RC. Laryngeal pathologies in dysphonic children with Down Syndrome. Int J Pediatr Otorhinolaryngol 2022; 157:111118. [PMID: 35405441 DOI: 10.1016/j.ijporl.2022.111118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/07/2022] [Accepted: 03/25/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Down syndrome is the most common chromosomal abnormality and is associated with a higher incidence of congenital heart defects, which often require surgery within the first year of life. Previous studies have found that children with Down syndrome are at higher risk for subglottic stenosis, vocal fold paralysis, and laryngomalacia. The goal of this study is to review children with Down syndrome presenting with dysphonia and to characterize their laryngeal pathologies. METHODS A retrospective review was performed of patients with Down syndrome seen at a tertiary pediatric hospital's department of otolaryngology from Jan. 2007-Jul. 2021 for voice-related concerns. Inclusion criteria included age less than 18 years, diagnosis of Trisomy 21, and complaint of dysphonia. The data extracted included history of dysphonia, co-morbidities, demographic information, age at presentation, perceptual voice assessments, voice quality of life scores, acoustic data, laryngoscopic and/or videostroboscopic exams, and surgical procedures. RESULTS Twenty-three total patients met the study criteria. Of these children, 13 (57%) were male and 10 (43%) were female. The mean age at first presentation was 4.08 years (range 12 days-16.3 years). Eleven of the 23 patients presented within the first 12 months of life. Sixteen patients were diagnosed with vocal fold immobility, 13 of which were left-sided unilateral immobility and the remaining 3 were bilateral immobility. 5 patients were diagnosed with vocal fold nodules. 12 children in the immobility group had a history of cardiothoracic surgery at our institution. Only 3 patients had Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) assessments, though all three showed overall dysphonia ratings of severely deviant, with roughness and strain scores being the most severe. DISCUSSION The most common etiology of dysphonia in our Down syndrome patient population was vocal fold immobility and hypomobility, as opposed to vocal fold nodules (which is the most common in the general pediatric population). The higher likelihood of cardiac surgery in patients with Trisomy 21 may result in the increased incidence of vocal fold immobility. There should be a low threshold to refer dysphonic patients with Down syndrome for laryngoscopic evaluation, as treatment options may be available.
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Affiliation(s)
- Anne F Hseu
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, USA.
| | - Grant P Spencer
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
| | - Stacy Jo
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
| | - Roseanne Clark
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
| | - Roger C Nuss
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
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