Reliability of perceptions of voice quality: evidence from a problem asthma clinic population

<p>Introduction: Methods of perceptual voice evaluation have yet to achieve satisfactory consistency; complete acceptance of a recognised clinical protocol is still some way off.</p> <p>Materials and methods: Three speech and language therapists rated the voices of 43 patients attending the problem asthma clinic of a teaching hospital, according to the grade-roughness-breathiness-asthenicity-strain (GRBAS) scale and other perceptual categories.</p> <p>Results and analysis: Use of the GRBAS scale achieved only a 64.7 per cent inter-rater reliability and a 69.6 per cent intra-rater reliability for the grade component. One rater achieved a higher degree of consistency. Improved concordance on the GRBAS scale was observed for subjects with laryngeal abnormalities. Raters failed to reach any useful level of agreement in the other categories employed, except for perceived gender.</p> <p>Discussion: These results should sound a note of caution regarding routine adoption of the GRBAS scale for characterising voice quality for clinical purposes. The importance of training and the use of perceptual anchors for reliable perceptual rating need to be further investigated.</p&gt

Objective dysphonia quantification in vocal fold paralysis: comparing nonlinear with classical measures

Clinical acoustic voice recording analysis is usually performed using classical perturbation measures including jitter, shimmer and noise-to-harmonic ratios. However, restrictive mathematical limitations of these measures prevent analysis for severely dysphonic voices. Previous studies of alternative nonlinear random measures addressed wide varieties of vocal pathologies. Here, we analyze a single vocal pathology cohort, testing the performance of these alternative measures alongside classical measures.

We present voice analysis pre- and post-operatively in unilateral vocal fold paralysis (UVFP) patients and healthy controls, patients undergoing standard medialisation thyroplasty surgery, using jitter, shimmer and noise-to-harmonic ratio (NHR), and nonlinear recurrence period density entropy (RPDE), detrended fluctuation analysis (DFA) and correlation dimension. Systematizing the preparative editing of the recordings, we found that the novel measures were more stable and hence reliable, than the classical measures, on healthy controls.

RPDE and jitter are sensitive to improvements pre- to post-operation. Shimmer, NHR and DFA showed no significant change (p > 0.05). All measures detect statistically significant and clinically important differences between controls and patients, both treated and untreated (p < 0.001, AUC > 0.7). Pre- to post-operation, GRBAS ratings show statistically significant and clinically important improvement in overall dysphonia grade (G) (AUC = 0.946, p < 0.001).

Re-calculating AUCs from other study data, we compare these results in terms of clinical importance. We conclude that, when preparative editing is systematized, nonlinear random measures may be useful UVFP treatment effectiveness monitoring tools, and there may be applications for other forms of dysphonia.
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Ishodi glasovne terapije nakon lobektomije i totalne tireoidektomije

Voice disorders are among the most common complications of thyroid surgery. It is therefore advisable to continuously monitor and report the outcomes of voice rehabilitation among people who underwent thyroid surgery in order to recognize which specific clinical actions are necessary to give those patients the maximum chance to restore quality of life. The aim of this study was to examine the outcomes of voice therapy in 35 persons (26 women and 9 men) aged between 20 and 75 years after total thyroidectomy or lobectomy. Multidimensional voice assessment using the GRBAS scale, Voice Handicap Index questionnaire, and acoustic analysis was carried out before and after voice therapy, which included relaxation and breathing exercises, laryngeal massage, resonance therapy, and the employment of the digital compression method. Since the Wilcoxon Signed Ranks Test showed significant improvements in all voice parameters after voice therapy, voice rehabilitation seems to be the essential clinical activity for thyroid surgery patients who suffer from voice disorders postoperatively.Poremećaji glasa su među najčešćim posljedicama operacije štitne žlijezde. Stoga je preporučljivo kontinuirano izvještavati o rezultatima rehabilitacije glasa kod ljudi koji su prošli operaciju štitnjače, kako bi se prepoznalo koje su specifične kliničke radnje potrebne da bi se tim pacijentima pružila maksimalna šansa za vraćanje prijašnje kvalitete života. Cilj ovog istraživanja bio je ispitati rezultate glasovne terapije 35 osoba (26 žena i 9 muškaraca) u dobi između 20 i 75 godina, nakon lobektomije ili totalne tireoidektomije štitne žlijezde. Multidimenzionalna procjena glasa putem GRBAS ljestvice, upitnika Indeks vokalnih teškoća i akustičke analize provedena je prije i nakon terapije glasa, koja je uključivala vježbe opuštanja i disanja, masažu larinksa, rezonantnu terapiju i primjenu metode digitalne kompresije. Budući da je primjena Wilcoxonovog testa pokazala značajna poboljšanja u mjerenim parametrima nakon terapije glasa, čini se da je rehabilitacija glasa ključna klinička aktivnost za pacijente s operacijom štitne žlijezde kod kojih je postoperativno dijagnosticiran poremećaj glasa

Gender-related differences in the prevalence of voice disorders and awareness of dysphonia

Objective: Considering the impact of dysphonia on public health and the increasing attention to patient-centred care, we evaluated sex-related differences in the prevalence of benign voice disorders, awareness of dysphonia and voice therapy (VT) results. Methods: One hundred and seventy-one patients, 129 females and 42 males, with functional or organic benign dysphonia underwent Voice Handicap Index (VHI), auditory-perceptual dysphonia severity scoring (GRBAS) and acoustic analysis (Jitter%, Shimmer%, NHR) before and after VT. Results: Prevalence of each voice disorder was significantly higher among females. Mean time-to-diagnosis (time elapsed until medical consultation) was not different between males and females. The refusal of therapy and VT adherence (mean number of absences and premature dropout) were similar in the two groups. Pre-VT VHI and "G" parameter were worse in women. The percentage of women with abnormal acoustic analysis was significantly higher. Post-VT VHI gain was higher in women, whereas "G" parameter improvement did not differ by sex. Conclusions: Our study showed a higher prevalence of voice disorders in females. Awareness of dysphonia was not gender related. Females started with worse voice subjective perception and acoustic analysis, but they perceived greater improvement after therapy

Validity and reliability of the 2nd European Portuguese version of the “Consensus Auditory-Perceptual Evaluation of Voice” (II EP CAPE-V)

A thesis submitted in partial fulfillment of the requirement for the degree of Master in Science at the Health Science School of Polytechnic Institute of SetúbalIntroduction: Auditory-perceptual evaluation of voice is a part of a multidimensional voice evaluation, and is claimed to be “golden standard”. The “Consensus Auditory-Perceptual Evaluation of Voice” (CAPE-V) has been demonstrated to be a valid and reliable instrument for voice evaluation, when applied in both clinical and scientific research fields. The CAPE-V was first translated into European Portuguese (EP) (Jesus et al., 2009) however it revealed some validity and reliability problems. The purpose of this study was to assure a valid and reliable EP version of CAPE-V. This resulted in the 2nd EP version of CAPE-V (II EP CAPE-V), with permission granted by ASHA. Method: This was a transversal, observational, descriptive, and comparative study. 14 Speech-language pathologists (SLPs) voice experts (>5 years of clinical practice), rated a total of 26 voice samples produced by 10 males (mean age=45) and 10 females (mean age=43) classified into two groups: a control group (n=10) and a dysphonic group (n=10), with subjects matched for age and gender. All voice samples were rated in one session with the II EP CAPE-V, and in a second session one week later with GRBAS. Content validity was supported by 6 new sentences conceptualized and adapted to EP linguistic and cultural context according to the rationale outlined in the original CAPE-V protocol. For construct validity analysis, an independent samples t-test (α=.05) was performed for all vocal parameter. Concurrent validity was estimated with the multi-serial correlation coefficient between II EP CAPE-V and GRBAS parameters (r>.70). Reliability was performed for all vocal parameters. Inter-rater reliability was determined by ICC, and intra-rater reliability by Pearson’s correlation coefficient (r>.70). Results/conclusion: Content validity was assured by an EP linguistic expert, who reviewed the six new sentences. Construct validity was obtained for all voical parameters (p.89) for overall severity/grade, roughness, and breathiness parameters. High inter-rater reliability (ICC>.84) was obtained for all parameters. Intra-rater reliability was high (r>.87) for overall severity, breathiness, and pitch; good (r=.73) for strain; and moderate (r>.69) for roughness and loudness parameters. The II EP CAPE-V is a valid and reliable instrument for auditory-perceptual evaluation, with all psychometric characteristics established

Spasmodic dysphonia, perceptual and acoustic analysis: presenting new diagnostic tools

In this article, we investigate whether (1) the IINFVo (Impression, Intelligibility, Noise, Fluency and Voicing) perceptual rating scale and (2) the AMPEX (Auditory Model Based Pitch Extractor) acoustical analysis are suitable for evaluating adductor spasmodic dysphonia (AdSD). Voice recordings of 12 patients were analysed. The inter-rater and intra-rater consistency showed highly significant correlations for the IINFVo rating scale, with the exception of the parameter Noise. AMPEX reliably analyses vowels (correlation between PUVF (percentage of frames with unreliable F0/voicing 0.748), running speech (correlation between PVF (percentage of voiced frames)/voicing 0.699) and syllables. Correlations between IINFVo and AMPEX range from 0.608 to 0.818, except for noise. This study indicates that IINFVo and AMPEX could be robust and complementary assessment tools for the evaluation of AdSD. Both the tools provide us with the valuable information about voice quality, stability of F0 (fundamental frequency) and specific dimensions controlling the transitions between voiced and unvoiced segments