A novel laryngeal palpatory scale (LPS) in patients with muscle tension dysphonia

Objectives: Laryngeal palpation is a routine clinical method for evaluation of patients with muscle tension dysphonia (MTD). The aim of this study was to develop a new comprehensive valid and reliable “laryngeal palpatory scale” (LPS), based on psychometric criteria. Methods: The scale items were selected based on an in-depth analysis of the literature and an expert focus group. Scale item generation and item reduction were followed by a psychometric assessment. Qualitative and quantitative content validity (the content validity ratio (CVR), content validity index (CVI)), the qualitative face validity, and the inter-rater reliability were determined. For this purpose, 531 patients were assessed and finally 55 patients with primary MTD (26 women, mean age: 40.8 years, SD: 12.5; 29 male, mean age: 41.6 years, SD: 11.8) participated in the study. A weighted kappa (k*) statistic was used to examine the inter-rater reliability for each single item. Results: Based on the CVR, three items were omitted because they had a score of less than 0.62. The CVI for all remaining items was greater than 0.79 and the scale CVI was equal to 0.96. The final 45 items were a result of the study. The inter-rater reliability for each single item ranged from 0.41 to 1, indicating moderate to almost perfect agreement. Conclusions: The LPS is a reliable and valid instrument for assessing patients with MTD. However, future studies are needed to provide adequate data on sensitivity, specificity, concurrent validity, and cutoff scores

Comparing acoustic and perceptual voice parameters in female teachers based on voice complaints

Background and Aim: Teachers are a large group of professional voice users that several risk factors and voice demands causes various voice complaints among them. As the voice is multidimensional, the aim of this study was acoustic and perceptual measurement of teachers’ voice and comparing the findings between two groups with many and few voice complaints.Methods: Sixty female teachers of high school in Sari, north of Iran, were chosen by available sampling to participate in this cross-sectional study. According to a voice complaints questionnaire, 21 subjects located in few voice complaints and 31 in many voice complaints group. After a working day, subjects completed a voice self-assessment questionnaire. Also, teachers’voice were recorded during three tasks including sustained vowels /a/ and /i/, text reading and conversational speech. Acoustic parameters were analyzed by Praat software and 2 speech-language pathalogists performed auditory-perceptual assessment by GRBAS ( Grade, Roughness, Breathiness, Asthenia, Strain ) scale. Results: Comparing of the voice self-assessment between the two groups demonstrated statistically significant difference (p<0.05); however results of the acoustic and auditory-perceptual measurement did not show significant diffrence.Conclusion: Despite prevalent voice problems in teachers, there are various conditions in terms of complaints and assessments methods. In this study, only a remarkable deviation documented in the client-based assessments in many voice compliants group in comparison with few voice compliants, which would be probably related to different individual’s perception of voice problem between two groups. These results support paying attention to self-assessments in clinical process of voice problems

Comparison of Perceptual Signs of Voice before and after Vocal Hygiene Program in Adults with Dysphonia

Background and Aim: Vocal abuse and misuse are the most frequent causes of voice disorders. Consequently some therapy is needed to stop or modify such behaviors. This research was performed to study the effectiveness of vocal hygiene program on perceptual signs of voice in people with dysphonia.Methods: A Vocal hygiene program was performed to 8 adults with dysphonia for 6 weeks. At first, Consensus Auditory- Perceptual Evaluation of Voice was used to assess perceptual signs. Then the program was delivered, Individuals were followed in second and forth weeks visits. In the last session, perceptual assessment was performed and individuals’ opinions were collected. Perceptual findings were compared before and after the therapy.Results: After the program, mean score of perceptual assessment decreased. Mean score of every perceptual sign revealed significant difference before and after the therapy (p≤0.0001). «Loudness» had maximum score and coordination between speech and respiration indicated minimum score. All participants confirmed efficiency of the therapy.Conclusion: The vocal hygiene program improves all perceptual signs of voice although not equally. This deduction is confirmed by both clinician-based and patient-based assessments. As a result, vocal hygiene program is necessary for a comprehensive voice therapy but is not solely effective to resolve all voice problems

The Effect of Pitch and Loudness levels of Phonation on Glottal Closure Pattern in People with Normal Voice

Objective: Glottal closure pattern is the most important stroboscopic sign for judgment about proper function of laryngeal function. Recent researches have suggested that complete glottal closure is not only normal glottal closure pattern. This research is aimed to investigate the closure pattern in normal subjects and the effect of phonation characteristics on it. Materials & Methods: In this cross-sectional and description- analytical study, 80 people (58 females & 22 males) were selected by random from 218 students. After taking history, perceptual and voice self-assessment, those were selected that the assessments showed do not have any voice problems. Then videostroboscopic examination was performed and recorded during producing /i/ in habitual, high, low, loud and soft levels of phonation. Glottal closure patterns were analyzed and compared in different phonation in males and females by Fisher test. Results: In general, complete closure was the most frequent pattern and Y posterior chink was the second one. The results revealed significant difference between male and female (P<0.001) and different phonation levels including habitual, high, low, loud and soft (P<0.001) in glottal closure pattern. Moreover, significant difference was observed in different levels of pitch in females (P<0.001) and in difference levels of loudness in males (P<0.001). Conclusion: Incomplete glottal closure patterns, particularly Y posterior chink are not unusual findings in normal voice. Alternation in phonation levels can change glottal closure pattern significantly, therefore all of the phonation levels should be assessed in videostroboscopic examination, although it is not in the same manner in males and female

Validity and reliability of oral picture-naming test in aphasic adults

Background and Aim: One of the common problems in many types of aphasia syndromes is word retrieval and/or production difficulty. So, designing a valid test that can examine this problem based on related processes and influencing factors is important. Picture confrontation naming is a typical method for assessing and treatment of word retrieval impairments. The aim of this study was determining the validity and reliability of oral picture-naming test in assessing word retrieval ability of aphasic adults.Methods: Content and face validity of the test, that contains the line drawings of 115 Persian nouns, were assessed by speech therapists, graphists and painters. Then, the test was administered on 10 aphasics and 30 age-, gender- and education-matched normal subjects in two steps. Construct validity and internal consistency of test were investigated. External consistency was analyzed by test-retest method.Results: The content and face validity of all items were more than 90 and 85 percents, respectively. There was a statistically significant difference between the mean scores of patients and normal subjects (p<0.001). The internal consistency of 0.98 was determined for the test. The intra-class correlation coefficient of this test was 0.98.Conclusions: The oral picture-naming test had good content, face and construct validity. Also, internal and external consistencies were high. So, this test is a valid instrument for assessing naming ability of aphasic patients by a variety and big set of picture

Fundamental Frequency, Jitter, and Shimmer of Adult Stuuters` and Nonstutteres` Voice

Background and Aim: Objective measurement is general and acoustic measurements in particular have become a substantial aspect of stuttering assessment during the last few decades. Measurements do not replace the perceptual judgment, but they allow a more precise diagnosis, provide more evidence for therapeutic interventions, and are useful as feedback for patients in therapy. The purpose of this investigation was to compare some adult male stutterers' and nonstutterers' acoustic features.Materials and Methods: Adult male stutterers and nonstutterers participated this case-control study. Their fluent reading of 20 sentences in Farsi, prolongation of vowels /a/ and /i/, and rhythmic counting from 1 to 20 were analyed with Dr. Speech software.Results: There were no significant differences between two groups in fundamental frequency (f0) and standard deviation of f0 in three speech samples (vowels /a/ and /i/, reading 20 sentences, and rhythmic counting from 1 to 20). No significant difference were between two groups for jitter and shimmer.Conclusion: Non significant differences between two groups are somewhat due to investigation of this parameters in fluent speech of stutterers and nonstutterers

Patient-Based Assessment of Effectiveness of Voice Therapy in Vocal Mass Lesions with Secondary Muscle Tension Dysphonia

Introduction: Use of patient-based voice assessment scales is an appropriate method that is frequently used to demonstrate effectiveness of voice therapy. This study was aimed at determining the effectiveness ofvoice therapy among patients with secondary muscle tension dysphonia (MTD) and vocal mass lesions.   Materials and Methods: The study design was prospective, with within-participant repeated measures. Thirty-three patients with secondary MTD and vocal mass lesions participated in the study, selected on the basis of voice history, laryngeal palpation, and videostroboscopy examination. An experienced otolaryngologist and one experienced speech language pathologist undertook the diagnostic process. Voice therapy included both direct and indirect techniques and lasted approximately 2 months for all included patients. The voice handicap index (VHI) was used to evaluate the effectiveness ofvoice therapy among included patients. Paired t-test, size of the standardized effect (ESI),and mean standardized response (ESII) were used to analyze effectiveness of the target voice therapy.   Results: The findings of this study indicate astatistically significant improvement after the voice therapy protocol (P1.96). Results of ESI and ESII demonstrate that the VHI scale is sufficiently responsive to detect voice therapy change (ES>0.8).   Conclusion: This study recommends a combination of direct and indirect voice therapy in the vocal rehabilitation of patients with secondary MTD and vocal mass lesions. Furthormore, we recommend use of the VHI scale to show voice therapy changes for both clinical and research purposes

Using Surface Electromyography to Compare Healthy Male and Female Laryngeal Muscles Activity

Background and Aim: Laryngeal muscles contribute in sound production play a key role in specific language. Needle electromyography is the specific complementary method for muscle activity evaluation which is awfully painful and needs serenity of patient. The purpose of this study was to use Surface electromyography as a probable new approach for evaluation of laryngeal muscles activity.Methods: 34 healthy women and 34 healthy men aged 20-30 years old were enrolled in this study. Each individual was seated in an armchair. Recording electrodes were placed bilaterally (right and left) in the low anterior neck at approximately one centimeter from midline on thyroarytenoid and cricothyroid muscles. Silent activity and fricative voice (/z/ , /ž/) and voiceless (/s/ , /š/) activities were recorded for ten seconds followed by 10 seconds of rest, for 5 repetition. All data were processed and frequency and non linear measurements were assessed. And were compared in time and frequency domain.Results: Muscle activity in fricative voice in both groups was greater than rest condition (p<0.05). Moreover, muscle activity median frequency was significantly more in men than women (p<0.001).Conclusion: Activity evaluation of thyroarytenoid and cricothyroid muscles using surface electromyography is difficult in women. That may be due to anatomical features such as length and width of neck in women

Validity and rater reliability of Persian version of the Consensus Auditory Perceptual Evaluation of Voice

Background and Aim: Auditory-perceptual assessment of voice a main approach in the diagnosis and therapy improvement of voice disorders. Despite, there are few Iranian studies about auditory-perceptual assessment of voice. The aim of present study was development and determination of validity and rater reliability of Persian version of the Consensus Auditory Perceptual Evaluation of Voice (CAPE -V).Methods: The qualitative content validity was detected by collecting 10 questionnaires from 9 experienced speech and language pathologists and a linguist. For reliability purposes, the voice samples of 40 dysphonic (neurogenic, functional with and without laryngeal lesions) adults (20-45 years of age) and 10 normal healthy speakers were recorded. The samples included sustain of vowels and reading the 6 sentences of Persian version of the consensus auditory perceptual evaluation of voice called the ATSHA.Results: The qualitative content validity was proved for developed Persian version of the consensus auditory perceptual evaluation of voice. Cronbach’s alpha was high (0.95). Intra-rater reliability coefficients ranged from 0.86 for overall severity to 0.42 for pitch; inter-rater reliability ranged from 0.85 for overall severity to 0.32 for pitch (p<0.05).Conclusion: The ATSHA can be used as a valid and reliable Persian scale for auditory perceptual assessment of voice in adults

Internal evaluation department of speech therapy, Tehran University of Medical Sciences

Background and Aim: Internal evaluation is an important part of organization monitoring. One of the Ministry of Health's policies is to encourage educational departments to conduct internal evaluations. The aim of internal evaluation of department of speech therapy was appraising its education, research and treatment qualities and determining its strengths, weaknesses, opportunities and threats (SWOTs) to identify the ways of overcoming weakness and threats.Methods: This descriptive cross-sectional study was conducted in 10 phases to evaluate 10 factors. Participants were undergraduate, graduate, and postgraduate students, academic staff, director of the department along with the patients. The internal evaluation software for educational and research centers released by Center of Medical Education Studies and Development was modified and utilized. Data was analyzed by calculating mean of means.Results: Mean of means from highest to lowest scores were respectively as follows: the quality of diagnosis, treatment and dealing with patients 4.15 out of 5; as well as the quality of academic staff 3.5 were in the range of desirable category; qualities of management and organizational structure 3.34, graduate students 3.21, teaching and learning processes 3.1, missions and goals 3.09, instructional methods and curriculum models 2.99, educational and research equipments 2.9, students 2.76 and research 2.67 were within the range of rather desirable category. Total score was 3.17 (63.4%) which was within the range of rather desirable category.Conclusion: The department of speech therapy was in rather desirable state before merger. That result was appropriate according to the department's conditions and supplies