Voice Therapy Improves Acoustic and Auditory-Perceptual Outcomes in Children

PURPOSE

This study employed acoustic measures as well as auditory-perceptual assessments to examine the effects of voice therapy in children presenting with benign vocal fold lesions.

METHODS

A retrospective, observational cohort design was employed. Sustained vowels produced by 129 children diagnosed with benign vocal fold lesions were analyzed, as well as connected speech samples produced by 47 children. Treatment outcome measures included Consensus of Auditory-Perceptual Evaluation of Voice (CAPE-V), jitter, shimmer, Noise-to-Harmonic Ratio (NHR), cepstral peak prominence (CPP), and Low-to-High Ratio (LHR) on sustained vowels, and CPP and LHR on connected speech.

RESULTS

Following voice therapy, significant improvements in CAPE-V ratings (p < 0.001) were observed. Additionally, jitter (p = 0.041), NHR (p = 0.019), and CPP (p < 0.01) on sustained vowels, and CPP (p = 0.002), and LHR (p = 0.008) on connected speech significantly improved following voice therapy. CPP increased with age in males but did not change in females. CAPE-V ratings and perturbation measures indicated that dysphonia was more severe in younger children pre and post-therapy.

CONCLUSIONS

Auditory-perceptual and acoustic measures demonstrated improved voice quality following voice therapy in children with dysphonia. CPP effectively quantified voice therapy gains and allowed for analysis of connected speech, in addition to sustained vowels. These findings demonstrate the value of CPP as a tool in assessing therapy outcomes and support the efficacy of voice therapy for children presenting with vocal fold lesions.

LEVEL OF EVIDENCE

4 Laryngoscope, 133:977-983, 2023.

Pediatric Voice Therapy: How Many Sessions to Discharge?

PURPOSE

Voice therapy is the primary treatment for children presenting with benign morphological vocal fold changes. This study examined the number of voice therapy sessions required to meet treatment goals and identified factors that predicted treatment length for pediatric voice patients.

METHOD

An observational cohort design was employed. Data were extracted from the University of Wisconsin-Madison Voice and Swallow Outcome Database. This study examined 62 children who completed a course of voice therapy with a speech-language pathologist (SLP) addressing dysphonia caused by benign vocal fold lesions. Extracted data included patient demographics, auditory-perceptual assessments, acoustic and aerodynamic voice measures, videostroboscopy ratings, and medical comorbidities. Linear regression was used to identify predictors of number of therapy sessions.

RESULTS

Patients received an average of 7.5 sessions of voice therapy prior to discharge. Baseline auditory-perceptual assessment of dysphonia (p = .032), phonation threshold pressure (PTP, p = .005), Glottal Function Index (GFI) score (p = .006), and glottic closure pattern (p = .023) were significant predictors of number of voice therapy sessions. These measures, as well as hourglass glottic closure, predicted longer intervention duration. The regression model had an overall r ² of .62.

CONCLUSIONS

Pediatric voice therapy addressing benign vocal fold lesions and/or laryngeal edema required an average of 7.54 sessions before voice outcomes were sufficiently improved for discharge. More severe overall SLP ratings of dysphonia, GFI scores, PTP, or hourglass glottic closure pattern significantly predicted increased number of therapy sessions prior to discharge. Future work should determine what other factors affect treatment duration and how the efficiency of pediatric voice therapy can be maximized.

Management of Pediatric Voice Disorders: Perceived Knowledge, Confidence, Attitude and Practice Patterns Among School-based Speech-language Pathologists in Hong Kong

OBJECTIVE

This survey evaluated the levels of self-perceived knowledge, confidence, attitude and practice patterns of school-based speech-language pathologists (SLPs) in Hong Kong regarding their management of pediatric voice disorders.

METHODS

SLPs with experience working in school settings in Hong Kong were invited to complete an anonymous online survey. The survey ascertained SLPs' perception of their knowledge, confidence, attitude and practice patterns regarding their management of pediatric voice disorders. It also explored the barriers and facilitators to effective service provision for children with voice problems in schools.

RESULTS

A total of 85 responses were received, of which 56 respondents with complete responses were selected for analysis. Results showed that respondents in general did not consider themselves having sufficient knowledge on pediatric voice. They did not feel fully confident in managing pediatric voice cases. Even though they exhibited a positive attitude and agreed that pediatric voice management was important, discrepancies were noted between their attitude and practice. Barriers that hinder practice include the lack of professional guidelines, insufficient time and resource as well as difficulties to conduct comprehensive voice assessments with children.

CONCLUSION

The study findings urge the needs of enhancing school-based SLPs' perceived knowledge and competence in managing pediatric voice disorders. The study also identifies strategic directions to improve service provision for children with voice disorders in schools.

The Relationship Between Auditory-Perceptual Rating Scales and Objective Voice Measures in Children With Voice Disorders

Purpose The purpose of this study was to determine concurrent validity of the Grade, Roughness, Breathiness, Asthenia, and Strain (GRBAS) and Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) auditory-perceptual scales in children with voice disorders. A secondary purpose was to determine correlation between the GRBAS, CAPE-V, and objective voice measures. Method GRBAS and CAPE-V ratings and acoustic and aerodynamic measures were collected from the University of Wisconsin-Madison Voice and Swallow Outcomes Database. Correlations between CAPE-V and GRBAS ratings were calculated for overall severity of dysphonia, roughness, breathiness, and strain. Correlations between auditory-perceptual voice ratings and objective voice measures were also examined. Results One hundred thirty GRBAS and CAPE-V auditory-perceptual ratings were significantly correlated for overall severity, roughness, breathiness, and strain. r ² values were highest for overall severity of dysphonia (r ² = .75) and lowest for strain (r ² = .54). CAPE-V and GRBAS ratings were largely associated with similar acoustic and aerodynamic measures. The highest correlations were observed for auditory-perceptual ratings of breathiness and jitter% (CAPE-V r ² = .44, GRBAS r ² = .44), shimmer% (CAPE-V r ² = .45, GRBAS r ² = .45), noise-to-harmonic ratio (CAPE-V r ² = .42, GRBAS r ² = .40), fundamental frequency (CAPE-V r ² = .47, GRBAS r ² = .44), and maximum phonation time (CAPE-V r ² = .56, GRBAS r ² = .51). Akaike information criterion values indicated that CAPE-V ratings were more strongly correlated with objective voice measures than GRBAS ratings. Conclusions CAPE-V and GRBAS scales have concurrent validity in children with voice disorders. CAPE-V ratings are more strongly correlated with acoustic and aerodynamic voice measures.

Relative Fundamental Frequency in Children With and Without Vocal Fold Nodules

Purpose Relative fundamental frequency (RFF) is an acoustic measure that is sensitive to functional voice differences in adults. The aim of the current study was to evaluate RFF in children, as there are known structural and functional differences between the pediatric and adult vocal mechanisms. Method RFF was analyzed in 28 children with vocal fold nodules (CwVN, M = 9.0 years) and 28 children with typical voices (CwTV, M = 8.9 years). RFF is the instantaneous fundamental frequency (f ₀) of the 10 vocalic cycles during devoicing (vocal offset) and 10 vocalic cycles during the revoicing (vocal onset) of the vowels that surround a voiceless consonant. Each cycle's f ₀ was normalized to a steady-state portion of the vowel. RFF values for the cycles closest to the voiceless consonant, that is, Offset Cycle 10 and Onset Cycle 1, were examined. Results Average RFF values for Offset Cycle 10 and Onset Cycle 1 did not differ between CwVN and CwTV; however, within-subject variability of Offset Cycle 10 was decreased in CwVN. Across both groups, male children had lower Offset Cycle 10 RFF values as compared to female children. Additionally, Onset Cycle 1 values were decreased in younger children as compared to those of older children. Conclusions Unlike previous work with adults, CwVN did not have significantly different RFF values than CwTV. Younger children had lower RFF values for Onset Cycle 1 than older children, suggesting that vocal onset f ₀ may provide information on the maturity of the laryngeal motor system.