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

Master of Science

thesisVocal tremor is a neurogenic voice disorder characterized by rhythmic modulation of pitch and loudness during sustained phonation and is acoustically measured as modulation of formants, fundamental frequency (fo), and sound pressure level (SPL). To date, links between oscillating vocal tract structures and acoustic modulation of the first two formants were shown in those with vocal tremor. However, laryngeal and respiratory contributions to acoustic modulation patterns in those with vocal tremor are difficult to separate. The purpose of this study was to compare acoustic patterns associated with volitional laryngeal versus respiratory structure oscillations in trained singers. Laryngeal oscillation was hypothesized to correspond with fo modulation patterns, whereas respiratory system oscillation was hypothesized to correspond with SPL modulation. Ten classically trained female singers with no less than 5 years' experience and no history or current complaints of voicing problems were recruited between 40-65 years of age. All participants underwent simultaneous recording of nasoendoscopic views of the larynx, respiratory kinematic and acoustic signals during three trials of sustained phonation of /i/ using either vibrato or the Accented Method of Voicing (AMV). Normalized measures of signal modulation rate and magnitude were completed on the acoustic (fo and SPL) and kinematic recordings. A mixed effects logistic regression compared within subject measurement differences between voicing conditions. The results showed significantly greater magnitude of respiratory kinematics during AMV (47.5% (+1.2)) than for vibrato (0% (+0) (p < .001) corresponding with significantly greater SPL modulation magnitude (AMV = 40% (+20); vibrato = (10% (+0)), respectively (p = .026). A significant difference was also found between voicing conditions for modulation rate of fo (p = .049) and SPL (p < .001). The rates of modulation during AMV were slower (fo = 2.8 (+ .8) Hz; SPL = 2.1 (+ .7) Hz) than for vibrato (fo = 5.1 (+ .7) Hz; SPL = 5 (+ .6) Hz). However, laryngeal kinematic and acoustic fo and SPL magnitude patterns did not differ between voicing conditions. Outcomes support predicted contributions of the respiratory system to voicing modulation; however, the larynx appears interactive with the respiratory and other speech structures during voicing

Tireoidektomija i poremećaji gutanja - pregled literature

This study aims to provide insight into the etiology and frequency of swallowing complications that arise after thyroidectomy and to outline the available diagnostic procedures by revising the existing literature on this topic. We conducted a bibliographic search using the electronic database MEDLINE /PubMed to identify all relevant articles and 44 studies were included in the review out of a total of 218 published articles. Dysphagia after thyroid surgery is a common postoperative complication which, in the short- or long-term, significantly affects patient life quality. There is no standard diagnostic protocol for thyroidectomy-related swallowing impairment. Among the reviewed studies, 8 questionnaires and 12 instrumental diagnostic tools were used to identify swallowing difficulties related to thyroid surgery. The Swallowing Impairment Index (SIS-6) was the most-used questionnaire. Fiberoptic endoscopy is a standard diagnostic tool performed prior and after thyroid surgery, primarily to identify changes in vocal fold mobility. Although instrumental findings usually reveal non-specific alterations of swallowing; swallowing videofluoroscopy and esophageal manometry can be the most helpful tools in further management of thyroidectomy dysphagia. In patients with thyroidectomy-related swallowing difficulties and suspected laryngopharyngeal reflux, 24-hour MII - pH metry should be performed.Kako bismo dali bolji uvid u etiologiju i učestalost komplikacija gutanja koje su posljedica tireoidektomije te prikazali dostupne dijagnostičke postupke, proveli smo bibliografsku pretragu koristeći elektroničku bazu podataka MEDLINE / PubMed. Od ukupno 218 objavljenih članaka, u recenziju su bile uključene 44 studije. Disfagija nakon operacije štitnjače uobičajena je postoperativna komplikacija koja, kratkoročno ili dugoročno, značajno utječe na kvalitetu života pacijenta. Ne postoji standardni dijagnostički protokol za oštećenje gutanja povezano s tireoidektomijom. U studijama uključenim u pregled literature korišteno je 8 upitnika i 12 instrumentalnih postupaka za dijagnosticiranje poremećaja gutanja povezanih s operacijom štitnjače. Indeks poremećaja gutanja (SIS -6) bio je najčešće korišteni upitnik. Fiberoptička endoskopija standardni je dijagnostički postupak koji se provodi prije i nakon operacije štitnjače, prvenstveno radi identifikacije promjena pokretljivosti glasnica. Iako su nalazi instrumentalnih dijagnostičkih postupaka obično nespecifični, videofluoroskopija gutanja i manometrija jednjaka daju najviše relevatnih podataka. U bolesnika s poteškoćama gutanja i sumnjom na laringofaringealni refluks potrebno je provesti 24-satnu MII pHmetriju

Degree of Vocal Handicap in Two Age Groups of Individuals

A healthy, functional voice is a critical aspect of daily life, allowing the expression of basic needs as well as interaction within an individual’s community. Unfortunately, for many adults the voice declines in later life. The purpose of this study was to investigate how normal vocal aging affects the quality of life of the elderly. Two hundred two adults without voice disorders from two age groups (30-50 and 65-85) completed the Voice Handicap Index. Results indicated that the older group felt a greater degree of vocal handicap than the younger age group [F (1,156) = 4.944, p = 0.028]. Implications of the study for care of the aging voice and areas for further research are discussed

Neurologic Music Therapy To Improve Speaking Voice In Individuals Diagnosed With Parkinson’s Disease

Parkinson’s disease (PD) is a neurodegenerative disease that affects dopamine production in the motor areas of the brain leading to impairments in muscular control (Parkinson’s Foundation, 2018). Impairments in motor functioning can also impact respiratory control and voice production (America Speech-Language-Hearing Association, 2018). Neurologic Music Therapy (NMT) techniques have demonstrated the ability of music-based interventions to improve maximum phonation time, voice quality, articulatory control, and quality of life in people with PD (Azekawa, &amp; LaGasse, 2018; Haneishi, 2001; Tamplin, 2008; Shih et al., 2012; Elefant, Baker, Lotan, Lagesen, &amp; Skeie, 2012). This study sought to investigate how a music therapy protocol using NMT techniques impacts vocal functioning in people with PD. The effectiveness of specific Neurologic Music Therapy techniques targeting respiratory control andimproving vocal functioning was explored. Six persons with idiopathic PD were enrolled in weekly one-hour music therapy sessions for 6 weeks. Data collection consisted of acoustic, perceptual, and self-report measures of voice were collected before and after a NMT intervention protocol. The acoustic and self-report measures were found to have no statistically significant differences from pre to post-intervention testing. The results from the perceptual measures yielded statistically significant differences for characteristics of breathiness, pitch, loudness, and overall severity of voice functioning. The results indicate that Neurologic Music Therapy interventions may be beneficial in improving speaking voice in individuals with PD. Further research with larger sample sizes and control groups are necessary to determine if resulting statistically significant differences are generalizable to the PD population to yield clinically relevant changes

Respiratory And Laryngeal Function In Teachers Pre- And Posta 1-Hour Vocal Loading Challenge

Teachers use their voice as a key part of their profession, often speaking at an increased loudness for multiple hours a day. This places teachers at a high risk for voice disorders, which costs the United States billions of dollars annually. Vocal fatigue, or worsening of the voice as the day progresses, is a common complaint from teachers. The present study investigated respiratory and laryngeal function in teachers pre and post a 1-hour vocal loading challenge. Six teachers and three student teachers (total of 9 subjects) produced four speech tasks and completed two perceptual ratings pre and post a 1-hour reading aloud vocal loading challenge in 70 dB multi-talker babble. Dependent variables included vocal tiredness and vocal effort ratings, cepstral peak prominence (CPP), low/high spectral ratio (L/H ratio), sound pressure level (SPL), utterance length (# of syllables), percent vital capacity expended per syllable (%VC/syllable), and lung volume initiation (%LVI-EEL), termination (%LVT-EEL), and excursion (%LVE). Following the vocal loading challenge, utterance length and SPL significantly increased, and %VC/syllable significantly decreased. %LVI-EEL increased post-vocal loading challenge, but it did not reach statistical significance. No laryngeal differences were found. These results suggest that subjects altered the respiratory system for three possible scenarios: to overcome perceived increase in difficulties for speech, to plan for longer utterances, or to overcome hyperventilation caused by the 1-hour vocal loading challenge

An Investigation of Vocal Abuse in School Teachers

The purpose of this study was to examine the effects of vocal abuse in school teachers and teacher\u27s aides pre and post one academic term. Vocal abuse was defined as any of several behaviors, including long periods of talking, yelling, smoking, consuming alcohol, etc. that can result in damage to the laryngeal mechanism. Initially, the participants of the study included fifteen elementary school teachers and five elementary teacher\u27s aides from two schools: the Red Lake Madsen Public School, and Golden Learning Center. Six participants were excluded from the study for various reasons. Participants were randomly assigned to either Group 1 or Group 2. Group 1 included two teacher\u27s aides and five teachers on a daily term (short term) and Group 2 included one teacher\u27s aide and six teachers during one academic term (long term). It was hypothesized that the school teachers and teacher\u27s aides who participated in vocally abusive behaviors will display differences in the measured vocal qualities pre and post testing. Data collection included voice recording productions of the vowels /a/. A paired samples t-test was used to determine if a statistically significant difference existed between teachers in the short term group versus the long term group and between pre and post terms. The results for the short term group revealed a statistically significant difference in one acoustic measure fundamental frequency

Is laryngeal hypersensitivity the basis of unexplained or refractory chronic cough?

Refractory chronic cough (RCC) and unexplained chronic cough (UCC) are common problems seen in primary care and subspecialty clinics. The role of cough hypersensitivity and laryngeal dysfunction in contributing to the persistence of cough in RCC/UCC is not well recognised. Data of patients with RCC and UCC evaluated in 2019 by an interdisciplinary cough clinic led by a pulmonologist and speech–language pathology team was reviewed. Patients completed validated questionnaires including the Leicester cough questionnaire (LCQ), voice handicap index (VHI) and dyspnoea index (DI) questionnaire at initial encounter. Presence of cough hypersensitivity was based upon a history of allotussia and hypertussia. Laryngeal dysfunction was diagnosed in those with a history of laryngeal paresthesias, throat clearing, voice abnormalities, upper airway dyspnoea and documentation of functional or anatomic laryngeal abnormalities on nasoendoscopy. Of the 60 UCC/RCC patients analysed, 75% of patients were female and 85% were over 40 years of age. Cough hypersensitivity was documented in all patients and multiple cough triggers occurred in 75% of patients. 95%, 50% and 25% of patients reported laryngeal paresthesias, voice abnormalities and upper airway dyspnoea, respectively. Significant associations between LCQ and VHI and DI scores occurred when adjusting for age, sex, ethnicity and body mass index. Laryngeal functional abnormalities were documented on 44 out of 60 patients on nasoendoscopy. Hypertussia, allotussia and laryngeal dysfunction are common in patients with RCC and UCC. Evaluation of UCC and RCC can delineate laryngeal hypersensitivity and allows appropriate treatment to be directed at this phenotype