A Review of Measures of Vocal Effort With a Preliminary Study on the Establishment of a Vocal Effort Measure

Objectives/Hypothesis. Vocal effort is the perceived exertion of voicing. Patients with voice disorders (VDs) frequently complain of increased effort, but currently there exists no empirically validated scale for the measurement of vocal effort. This article reviews the extant literature on vocal effort and its various definitions. It also presents a preliminary investigation on the use of a psychophysical scale, the Borg Category Ratio (CR-10), for vocal effort ratings. Study Design. A total of 28 participants with VDs and 28 healthy controls (HCs) underwent acoustic and aerodynamic voice measures in this prospective quasi-experimental group design. Methods. Vocal effort ratings using the Borg CR-10 gathered on vowels, standard sentences, and conversation were correlated with auditory-perceptual ratings, Voice Handicap Index scores, and phonation threshold pressure (PTP). Results. Results indicate that the Borg CR-10 is not sensitive to the presence of a VD but does correlate moderately well with other measures of VD severity, and may be clinically indicated for such use. Conclusions. Future research directions include task choice for vocal effort ratings, considerations during PTP protocols, intensive examiner and examinee training, and use of the Borg CR-10 for within-group separation of VD diagnosis