Journal of voice : official journal of the Voice Foundation.

1.
J Voice. 2020 Jan 16. pii: S0892-1997(19)30450-3. doi: 10.1016/j.jvoice.2019.12.008. [Epub ahead of print]
Development and Evidence of Content Validity of the Spectrographic Vocal Assessment Protocol (SVAP).
Bastilha GR1, Pagliarin KC2, Cielo CA2.

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Abstract

OBJECTIVE:

To develop and seek evidence of content validity of a spectrographic vocal assessment protocol.
METHODS:

Methodological study for development and validation of an assessment instrument. A broad literature search was conducted to develop and substantiate a spectrographic vocal assessment protocol. The protocol items were sent to five expert judges, speech therapists, nonauthors of the research, doctors, and clinicians, with experience in the field of voice and spectrographic acoustic analysis, who individually analyzed the protocol items. For data analysis, the Gwet analysis and the Content Validity Ratio formula were used.
RESULTS:

The Spectrographic Vocal Assessment Protocol was developed, subdivided into Broadband and Narrowband. Twenty-four protocol items had Content Validity Ratio 1.0 and 25 items had 0.6. Gwet analysis indicated substantial agreement (0.656) for broadband and almost perfect (0.848) for narrowband items.
CONCLUSION:

Evidence of satisfactory content validity was obtained in the development of the protocol.

Copyright © 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Acoustics; Spectrography; Speech, Language and Hearing Sciences; Validation Studies; Voice
PMID: 31955913 DOI: 10.1016/j.jvoice.2019.12.008

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Select item 303811452.
J Voice. 2019 Jul;33(4):564-566. doi: 10.1016/j.jvoice.2018.02.017. Epub 2018 Oct 29.
Injection Laryngoplasty in Patients With Puberphonia.
Hamdan AL1, Khalifee E2, Ghanem A2, Jaffal H2.

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Abstract


Puberphonia is a common vocal disorder characterized by the persistence of high vocal pitch postpuberty. Affected individuals may suffer from social impediments that can markedly affect their quality of life. Voice therapy is invariably offered as a main treatment modality with a successful outcome. Other treatment modalities include laryngeal framework surgery, cricothyroid muscle chemodenervation, and injection laryngoplasty. The authors of this manuscript report the impact of injection laryngoplasty on the average fundamental frequency in three cases of puberphonia.

Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Fundamental frequency; Injection laryngoplasty; Puberphonia; Vocal fold; Voice therapy
PMID: 30381145 DOI: 10.1016/j.jvoice.2018.02.017
[Indexed for MEDLINE]
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Select item 302243073.
J Voice. 2019 Jul;33(4):561-563. doi: 10.1016/j.jvoice.2017.12.017. Epub 2018 Sep 14.
Laryngeal Web as a Possible Cause for Nonabsorption of Vocal Nodules in Boys After Puberty.
Martins RHG1, Gramuglia ACJ2.

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Abstract

OBJECTIVES:

Vocal nodules are frequent in children and tend to be reabsorbed after puberty, especially in boys. The aims of the present study were to analyze the progression of nodules in boys after puberty and to investigate the role of microweb in the persistence of these lesions.
METHODS:

Clinical and videolaryngoscopy evaluations were carried out in boys with vocal nodules treated between 2009 and 2016, followed up to the age of 17 years or until remission of symptoms and reabsorption of the nodules. Boys with vocal nodules who underwent regular vocal therapy are included in the study. The outcomes were remission of symptoms and of the nodular lesions.
RESULTS:

A total of 34 boys with vocal nodules were diagnosed, of which 21 completed follow-up. Mean age of the first evaluation was 9 years (5-11 years) and of end of treatment was 14 years (13-18 years). Mean number of videolaryngoscopy per child was five. After adolescence there was complete remission of symptoms and of the lesions in 15 children (71.4%), partial remission in four (19.0%), and no remission of symptoms and of the lesions in two cases. In these two, videolaryngoscopy identified the presence of microweb and nodules.
CONCLUSIONS:

Favorable reabsorption of the vocal nodules after adolescence was observed in the majority of the boys who underwent voice therapy; however, in two cases there was no remission of symptoms and of the lesions. The unfavorable course can be attributed to anterior laryngeal microwebs.

Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Boys; Dysphonia; Larynx; Microweb; Vocal nodules
PMID: 30224307 DOI: 10.1016/j.jvoice.2017.12.017
[Indexed for MEDLINE]
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Select item 302205294.
J Voice. 2019 Jul;33(4):581.e7-581.e16. doi: 10.1016/j.jvoice.2018.01.022. Epub 2018 Sep 13.
Voice Disorder and Burnout Syndrome in Teachers.
de Brito Mota AF1, Giannini SPP2, de Oliveira IB3, Paparelli R4, Dornelas R5, Ferreira LP6.

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Abstract

OBJECTIVE:

The objective of this study was to assess the association between burnout syndrome and the likely presence of voice disorders among teachers from a public elementary school in the country town of Sergipe.
METHODS:

This is a cross-sectional study in which 208 teachers completed the following questionnaires: the Condition of Vocal Production-Teacher (CPV-P), the Screening Index for Voice Disorder (SIVD), and the Burnout Syndrome Evaluation Questionnaire (CESQT).
RESULTS:

Of the 208 teachers, 76.9% were women, 77.9% came from rural areas, and 64.4% were likely to have a voice disorder. Teachers with a career length of over 15 years were almost twice as likely to have a voice disorder. Of the symptoms listed in the SIVD, the following were most prevalent: dry throat (88.1%), hoarseness (84.4%), and fatigue when speaking (82.1%). Among the burnout subscales, psychic exhaustion was the most common (30.3%). Analyses revealed that probable voice disorder was associated with psychic exhaustion with an odds ratio of 1.78 (P < 0.001, χ2 = 84.1%). Teachers with positive scores on two to four burnout subscales had an odds ratio of 4.01 (P = 0.013, χ2 = 86.2%) for a probable voice disorder compared with those with positive scores on zero to one subscale.
CONCLUSIONS:

The present results confirmed that burnout syndrome was associated with the presence of a probable voice disorder.

Copyright © 2019. Published by Elsevier Inc.

KEYWORDS:

Occupational health; Professional exhaustion; Teachers; Voice; Voice disorders
PMID: 30220529 DOI: 10.1016/j.jvoice.2018.01.022
[Indexed for MEDLINE]
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MeSH terms


Select item 301396405.
J Voice. 2019 Jul;33(4):445-452. doi: 10.1016/j.jvoice.2018.01.019. Epub 2018 Aug 20.
Voice Disorders and Impact of Voice Handicap in Norwegian Student Teachers.
Greve K1, Bryn EK2, Simberg S3.

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Abstract

OBJECTIVES:

The primary objectives of the present study were to determine the prevalence of voice disorders in students studying to become elementary school teachers and to investigate the presence of potential risk factors for voice disorders. The amount of voice training offered during the students' education and the connection between voice disorders were also explored.
METHOD:

A web-based questionnaire was distributed to all elementary school student teachers throughout Norway. In total, 968 answers were received. The questionnaire consisted of questions on background, education, and risk factors; the Norwegian translation of the Voice Handicap Index (VHI-30(N)); and voice symptoms (Screen6).
RESULTS:

The results showed that 14.1% of the students had voice disorders, defined as experiencing two or more voice symptoms weekly or more often in Screen6. The most common symptoms were throat clearing, followed by strained or tired voice and sensation of pain or lump in the throat. The data showed a significant association between the scores of VHI-30(N) and results of Screen6. The amount of voice training within teacher education was not found to significantly reduce voice disorders. Results showed no significant differences in prevalence of voice disorders between female and male students.
CONCLUSIONS:

According to the answers given by the students participating in this study, voice problems appear to be common in student teachers. As they are to embark on a voice-demanding occupation, regular screening is paramount. More voice training is needed than offered in their education.

Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Risk factors; Student teacher; Symptoms; Voice disorders; Voice training
PMID: 30139640 DOI: 10.1016/j.jvoice.2018.01.019
[Indexed for MEDLINE]
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Select item 300722056.
J Voice. 2019 Jul;33(4):465-472. doi: 10.1016/j.jvoice.2017.12.006. Epub 2018 Jul 30.
Perceptual Assessment of Tracheoesophageal Voice Quality With the SToPS: The Development of a Reliable and Valid Tool.
Hurren A1, Miller N2, Carding P3.

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Abstract


Perceptual assessment of tracheoesophageal voice quality following total laryngectomy with surgical voice restoration is essential to investigate functional outcomes in relation to surgical procedure and rehabilitation regimes. There is no current tool with established reliability and validity to fulfill this purpose. This study describes the development of a set of new perceptual scales, in relation to core validity and reliability issues. These were investigated using voice stimuli from 55 voice prosthesis speakers and evaluated by 22 judges-12 speech and language therapists (SLTs), 10 Ear, Nose, and Throat surgeons-classified into experienced or not at assessing voice. SLT judges rated more parameters reliably than Ear, Nose, and Throat raters, and SLTs with specialist experience in laryngectomy and laryngeal voice attained the most parameters at an acceptable level of agreement. These scales are ready for clinical use, with the most optimal assessors being expert SLTs. Future studies are needed to ascertain precisely how reliability may relate to training, experience, voice stimuli type, and scale format.

Copyright © 2018 The Voice Foundation. All rights reserved.

KEYWORDS:

Alaryngeal voice; Laryngectomy; Perceptual voice; Surgical voice restoration; Voice assessment
PMID: 30072205 DOI: 10.1016/j.jvoice.2017.12.006
[Indexed for MEDLINE]
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Select item 300377777.
J Voice. 2019 Jul;33(4):435-440. doi: 10.1016/j.jvoice.2018.01.004. Epub 2018 Jul 20.
Cross-cultural Adaptation and Validation of the Persian Version of Voice Disability Coping Questionnaire (P-VDCQ): Introducing a New Instrument.
Faham M1, Ahmadi A2, Hosseinifar S3, Iravani K4, Azimi H5.

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Abstract

OBJECTIVES:

Coping is one of the important concepts in psychology, which is pertinent to how persons with illness manage the stress of that condition. Voice Disability Coping Questionnaire (VDCQ) is an assessment tool for quantifying coping strategies in those with voice disability. The purpose of the present study was to investigate reliability and validity of the Persian version of VDCQ (P-VDCQ).
METHOD:

Translation procedure was performed according to the World Health Organization guidelines, and then 138 persons (88 persons with voice disorders and 50 controls) completed the questionnaire. Psychometric properties of the P-VDCQ were investigated.
RESULTS:

There was a significant difference between the mean value of patients with dysphonia and that of the control group. The results of test-result reliability indicated that there is a high correlation between repeated administration of the questionnaire (intraclass correlation coefficient = 89.7). Also, a high Cronbach's alpha coefficient (α = 0.94) revealed a good internal consistency. Participants' scores in this instrument had a moderate correlation with their scores on Voice Activity Participation Profile-Persian version (r = 0.41, P < 0.001).
CONCLUSION:

The P-VDCQ is a reliable and a valid instrument that can be used to investigate coping strategies of patients with dysphonia in clinical settings and for research purposes.

Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Coping strategies; Dysphonia; Persian version; Psychometric properties; Voice Disability Coping Questionnaire
PMID: 30037777 DOI: 10.1016/j.jvoice.2018.01.004
[Indexed for MEDLINE]
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Select item 299360628.
J Voice. 2019 Jul;33(4):582.e5-582.e13. doi: 10.1016/j.jvoice.2018.02.013. Epub 2018 Jun 20.
The Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) Psychometric Characteristics: II European Portuguese Version (II EP CAPE-V).
de Almeida SC1, Mendes AP2, Kempster GB3.

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Abstract

OBJECTIVE:

The purpose of this study was to assure a reliable and valid European Portuguese (EP) version of Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V). This resulted in the second EP version of CAPE-V (II EP CAPE-V), with permission granted by American Speech-Language-Hearing Association.
STUDY DESIGN:

This is a transversal, observational, descriptive, and comparative study.
METHODS:

Retranslation of CAPE-V into EP was reviewed by an EP linguistic expert for content validity. A total of 20 subjects: 10 male individuals (mean age = 45) and 10 female individuals (mean age = 43) formed a control group (n = 10) and a dysphonic group (n = 10) were matched by age and gender. All subjects' CAPE-V phonatory tasks were captured with PEYLE PMENI (China) microphone and recorded with TASCAM DR-05 (Tokyo, Japan). Fourteen speech-language pathologists voice experts (>5 years of clinical practice) rated 26 voice samples with 6 repeated samples added for intrarater reliability. All voice samples were heard using AKG K101 (Europe) headphones and were rated in two sessions with a 1-week interval: one with the II EP CAPE-V; and the second with the GRBAS scale to establish for inter-rater reliability and construct and concurrent validity. Statistical analysis for inter-rater reliability was obtained with the intraclass correlation coefficient. Intrarater reliability was obtained with Pearson correlation. Construct and concurrent validity were performed with Student t test and multiserial correlation coefficient, respectively. SPSS 22.0 (IBM Corp, Armonk, NY) and LISREL 8.8 (Scientific Software International, Inc, Chicago, IL) were used with significance level cut-off points: r > 0.70 and α = 0.05.
RESULTS:

High inter-rater reliability was obtained for all vocal parameters (intraclass correlation coefficient  > 0.84) revealing good equivalence. Intrarater reliability was high (r > 0.87) for overall severity, breathiness, and pitch; good (r = 0.73) for strain; and moderate (r > 0.61) for roughness and loudness. These results revealed good reproducibility and stability of the II EP CAPE-V over time. Content validity was assured by an EP linguistic expert. Construct validity was obtained for all vocal parameters (P < 0.05), except for strain (P = 0.52), revealing these were the salient parameters for rating normal and dysphonic voices samples. Concurrent validity between the II EP CAPE-V and the GRBAS scales had strong correlations (r > 0.89) for overall severity/grade, roughness, and breathiness parameters, suggesting both instruments measure the same construct.
CONCLUSIONS:

The II EP CAPE-V is a reliable and valid instrument for auditory-perceptual evaluation of the EP population, with all psychometric measures assured.

Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Auditory-perceptual evaluation; CAPE-V; Voice disorders; Voice evaluation; Voice quality
PMID: 29936062 DOI: 10.1016/j.jvoice.2018.02.013
[Indexed for MEDLINE]
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Select item 299035369.
J Voice. 2019 Jul;33(4):582.e15-582.e22. doi: 10.1016/j.jvoice.2018.01.005. Epub 2018 Jun 11.
Evaluation of Psychometric Properties of Voice Activity and Participation Profile (VAPP): A Spanish Version.
Bermúdez-de-Alvear RM1, Gálvez-Ruiz P2, Martínez-Arquero AG3, Rando-Márquez S4, Fernández-Contreras E4.

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Abstract

OBJECTIVES:

This study aimed to analyze the psychometric properties of the Spanish version of the Voice Activity and Participation Profile (SVAPP) questionnaire.
STUDY DESIGN:

A randomized, cross-sectional sampling strategy with controls was used.
METHODS:

Two samples with a total of 169 participants were analyzed, specifically 61 men (mean age 37.02) and 108 women (mean age 37.78). Of these participants, 112 were patients and 57 were controls. The instrument was submitted to reliability (internal consistency and corrected item-total correlations) and reproducibility analyses. Validation assessment was based on the construct validity, convergent validity, discriminant validity, and concurrent validity.
RESULTS:

The global internal consistency was excellent (Cronbach's α = 0.976), corrected item-total correlations were satisfactory and ranged 0.63-0.89, and factor loadings were above 0.50. The different subscales showed good internal consistency (alpha coefficients ranged 0.830-0.956) and test-retest values were consistently associated. The exploratory factor analysis evidenced a strongly defined five factors internal structure, with factors loadings ranging 0.51-0.86. Convergent validity demonstrated that all subscales and scores were very strongly correlated (Pearson r above 0.735) and significantly associated. The discriminant validity analysis showed that SVAPP had good specificity to distinguish dysphonic from healthy voice subjects. Concurrent validity with Voice Handicap Index Spanish version (SVHI) showed very strong correlations between total scores, and between SVHI total score and SVAPP Daily and Social Communication subscales; correlations between both tests subscales were strong; only between SVAPP Work and SVHI Physical sections correlations were moderate.
CONCLUSIONS:

The findings of the present study demonstrated evidence for the SVAPP questionnaire reliability and validity, and provided insightful implications of voice disorders on Spanish patients' quality of life. However, further investigations are required.

Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Activity limitation; Participation restriction; Quality of life; Reliability; Voice
PMID: 29903536 DOI: 10.1016/j.jvoice.2018.01.005
[Indexed for MEDLINE]
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Select item 2988451010.
J Voice. 2019 Jul;33(4):490-496. doi: 10.1016/j.jvoice.2018.01.025. Epub 2018 Jun 5.
Impact Stress in Water Resistance Voice Therapy: A Physical Modeling Study.
Horáček J1, Radolf V2, Laukkanen AM3.

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Abstract

OBJECTIVES:

Phonation through a tube in water is used in voice therapy. This study investigates whether this exercise may increase mechanical loading on the vocal folds.
STUDY DESIGN:

This is an experimental modeling study.
METHODS:

A model with three-layer silicone vocal fold replica and a plexiglass, MK Plexi, Prague vocal tract set for the articulation of vowel [u:] was used. Impact stress (IS) was measured in three conditions: for [u:] (1) without a tube, (2) with a silicon Lax Vox tube (35 cm in length, 1 cm in inner diameter) immersed 2 cm in water, and (3) with the tube immersed 10 cm in water. Subglottic pressure and airflow ranges were selected to correspond to those reported in normal human phonation.
RESULTS:

Phonation threshold pressure was lower for phonation into water compared with [u:] without a tube. IS increased with the airflow rate. IS measured in the range of subglottic pressure, which corresponds to measurements in humans, was highest for vowel [u:] without a tube and lower with the tube in water.
CONCLUSIONS:

Even though the model and humans cannot be directly compared, for instance due to differences in vocal tract wall properties, the results suggest that IS is not likely to increase harmfully in water resistance therapy. However, there may be other effects related to it, possibly causing symptoms of vocal fatigue (eg, increased activity in the adductors or high amplitudes of oral pressure variation probably capable of increasing stress in the vocal fold). These need to be studied further, especially for cases where the water bubbling frequency is close to the acoustical-mechanical resonance and at the same time the fundamental phonation frequency is near the first formant frequency of the system.

Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Biomechanical loading; Biomechanics of voice; Phonation into a tube; Vocal exercises; Vocal fatigue
PMID: 29884510 DOI: 10.1016/j.jvoice.2018.01.025
[Indexed for MEDLINE]
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MeSH terms, Substances


Select item 2986129211.
J Voice. 2019 Jul;33(4):401-411. doi: 10.1016/j.jvoice.2018.01.003. Epub 2018 May 31.
Fundamental Frequency Estimation of Low-quality Electroglottographic Signals.
Herbst CT1, Dunn JC2.

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Abstract


Fundamental frequency (fo) is often estimated based on electroglottographic (EGG) signals. Because of the nature of the method, the quality of EGG signals may be impaired by certain features like amplitude or baseline drifts, mains hum, or noise. The potential adverse effects of these factors on fo estimation have to date not been investigated. Here, the performance of 13 algorithms for estimating fo was tested, based on 147 synthesized EGG signals with varying degrees of signal quality deterioration. Algorithm performance was assessed through the standard deviation σfo of the difference between known and estimated fo data, expressed in octaves. With very few exceptions, simulated mains hum, and amplitude and baseline drifts did not influence fo results, even though some algorithms consistently outperformed others. When increasing either cycle-to-cycle fo variation or the degree of subharmonics, the SIGMA algorithm had the best performance (max. σfo = 0.04). That algorithm was, however, more easily disturbed by typical EGG equipment noise, whereas the NDF and Praat's auto-correlation algorithms performed best in this category (σfo = 0.01). These results suggest that the algorithm for fo estimation of EGG signals needs to be selected specifically for each particular data set. Overall, estimated fo data should be interpreted with care.

Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

EGG; Electroglottography; Fundamental frequency; f(o)
PMID: 29861292 DOI: 10.1016/j.jvoice.2018.01.003
[Indexed for MEDLINE]
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Select item 2980769312.
J Voice. 2019 Jul;33(4):580.e21-580.e30. doi: 10.1016/j.jvoice.2018.01.006. Epub 2018 May 25.
Speaking Voice in Children and Adolescents: Normative Data and Associations with BMI, Tanner Stage, and Singing Activity.
Berger T1, Peschel T2, Vogel M2, Pietzner D2, Poulain T3, Jurkutat A3, Meuret S4, Engel C5, Kiess W3, Fuchs M6.

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Abstract

OBJECTIVES:

The aim of this study was to establish normative data concerning the speaking voice of children and adolescents for clinical diagnostics.
STUDY DESIGN:

Population-based mixed cross-sectional and longitudinal childhood cohort study.
METHODS:

Normative data measuring the speaking voice profile of 1352 male and 1274 female participants aged 6 to 17 years were collected. To evaluate the voice range, five different intensity levels as the quietest voicing speaking voice (Level I), conversational voice (Level II), classroom voice (Level III), shouting voice (Level IV), and again the quietest speaking voice (Level V) were investigated. Multivariable analyses were performed to describe the effects of body mass index, Tanner stage, and singing activity on the outcome variables.
RESULTS:

A clear distinction in frequencies and sound pressure levels between the five different voice levels can be found in both genders. In females the mean fundamental frequency of the conversational voice lowers from 223.3 to 205.8 Hz. In male participants it lowers from 223.3 to 102.3 Hz. The most substantial decrease in the fundamental frequency of the speaking voice in boys occurs at 13.5 years. Girls show an almost continuous decline in their fundamental frequency. Only the Tanner stage showed significant positive relationships with the grade of lowering of the fundamental frequency in both sexes.
CONCLUSIONS:

It was shown that the investigation of the speaking voice using predefined intensity-levels represents a feasible examination for children and adolescents. This study provides reference data on the range and age-adjusted normative values of the speaking voice.

Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Adolescence; Fundamental frequency; Pediatric voice; Speaking voice; Voice change
PMID: 29807693 DOI: 10.1016/j.jvoice.2018.01.006
[Indexed for MEDLINE]
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Select item 2980480313.
J Voice. 2019 Jul;33(4):473-481. doi: 10.1016/j.jvoice.2017.12.018. Epub 2018 May 24.
Perceptual and Quantitative Assessment of Dysphonia Across Vowel Categories.
Anand S1, Skowronski MD2, Shrivastav R3, Eddins DA4.

Author information


Abstract

OBJECTIVES:

This study aims to determine the sensitivity of perceptual and computational correlates of breathy and rough voice quality (VQ) across multiple vowel categories using single-variable matching tasks (SVMTs).
METHODS:

Sustained phonations of /a/, /i/, and /u/ from 20 dysphonic talkers (10 with primarily breathy voices and 10 with primarily rough voices) were selected from the University of Florida Dysphonic Voice Database. For primarily breathy voices, perceived breathiness was judged, and for primarily rough voices, perceived roughness was judged by the same group of 10 listeners using an SVMT with five replicates per condition. Measures of pitch strength, cepstral peak, and autocorrelation peak were applied to models of the perceptual data.
RESULTS:

Intra- and inter-rater reliability were high for both the breathiness and the roughness perceptual tasks. For breathiness judgments, the effect of vowel was small. Averaged over all talkers and listeners, breathiness judgments for /a/, /i/, and /u/ were -11.6, -11.2, and -12.2 dB noise-to-signal ratio, respectively. For roughness judgments, the effect of vowel was larger. The perceived roughness of /a/ was higher than /i/ or /u/ by 3 dB modulation depth. Pitch strength was the most accurate predictor of breathiness matching (r2 = 0.84-0.94 across vowels), and log-transformed autocorrelation peak was the most accurate predictor of roughness matching (r2 = 0.59-0.83 across vowels).
CONCLUSIONS:

Breathiness is more consistently represented across vowels for dysphonic voices than roughness. This work represents a critical step in advancing studies of voice quality perception from single vowels to running speech.

Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Cepstral peak; Pitch strength; Single-variable matching task (SVMT); Voice quality; Vowel category
PMID: 29804803 DOI: 10.1016/j.jvoice.2017.12.018
[Indexed for MEDLINE]
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Select item 2979387514.
J Voice. 2019 Jul;33(4):516-525. doi: 10.1016/j.jvoice.2018.01.014. Epub 2018 May 21.
The Developing Female Chorister Voice: Case-Study Evidence of Musical Development.
Howard DM1, Welch GF2, Himonides E2, Owens M3.

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Abstract


The human singing voice changes throughout the lifespan and there are gender-specific variations that need to be taken into account. Life changes in terms of voice are different for females and males and this paper concentrates on the female singing voice in the context of choral singing. Case-study data from three choristers are presented relating to the changing female voice during puberty as part of a longitudinal study of female choristers in a major English Cathedral Choir School. In addition, discussion is presented on important considerations with respect to the female choral singing voice with a particular focus on specific choral aspects during rehearsals and performance.

Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Choral; Chorister; Girls; Performance; Singing
PMID: 29793875 DOI: 10.1016/j.jvoice.2018.01.014
[Indexed for MEDLINE]
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MeSH terms


Select item 2979387415.
J Voice. 2019 Jul;33(4):581.e17-581.e23. doi: 10.1016/j.jvoice.2018.01.015. Epub 2018 May 21.
Validity and Reliability Study of Bahasa Malaysia Version of Voice Handicap Index-10.
Ong FM1, Husna Nik Hassan NF2, Azman M1, Sani A1, Mat Baki M3.

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Abstract

OBJECTIVES:

This study aimed to determine the validity and reliability of Bahasa Malaysia version of Voice Handicap Index-10 (mVHI-10).
MATERIALS AND METHODS:

This cross-sectional study was carried out in the Otorhinolaryngology, Head and Neck Surgery Department of Universiti Kebangsaan Malaysia Medical Centre (UKMMC) from June 2015 to May 2016. The mVHI-10 was produced following a rigorous forward and backward translation. One hundred participants, including 50 healthy volunteers (17 male, 33 female) and 50 patients with voice disorders (26 male, 24 female), were recruited to complete the mVHI-10 before flexible laryngoscopic examinations and acoustic analysis. The mVHI-10 was repeated in 2 weeks via telephone interview or clinic visit. Its reliability and validity were assessed using interclass correlation.
RESULTS:

The test-retest reliability for total mVHI-10 and each item score was high, with the Cronbach alpha of >0.90. The total mVHI-10 score and domain scores were significantly higher (P < 0.001) in the pathology groups (20.92 ± 8.74) than healthy volunteers (1.54 ± 1.97), depicting excellent discriminant validity. The Kaiser-Meyer-Olkin measure was 0.92, which depicted excellent construct validity. There was a significant positive correlation between the mVHI-10 score and jitter and shimmer result (P < 0.001).
CONCLUSIONS:

The present study showed good reliability and validity of the mVHI-10 when applied to both healthy volunteers and patients with voice disorders. We recommend the use of the mVHI-10 in daily clinical practice among Bahasa Malaysia-speaking population.

Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Bahasa Malaysia version; Dysphonia; Quality of life; Voice Handicap Index-10; Voice disorder
PMID: 29793874 DOI: 10.1016/j.jvoice.2018.01.015
[Indexed for MEDLINE]
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Select item 2975344516.
J Voice. 2019 Jul;33(4):567-574. doi: 10.1016/j.jvoice.2018.01.008. Epub 2018 May 9.
The Utility of Pulmonary Function Testing in Patients Presenting With Dysphonia.
Meenan K1, Catanoso L1, Aoyama J1, Stephan SR1, Chauvin R1, Sataloff RT2.

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Abstract

OBJECTIVE:

We aimed to evaluate the utility of pulmonary function testing (PFT), particularly forced expiratory flow (FEF) 25-75%, in patients presenting with dysphonia.
STUDY DESIGN:

A retrospective chart review was carried out.
METHODS:

Records of 199 patients who presented with dysphonia were reviewed to determine whether in-office PFTs, which we perform routinely, lead to new pulmonary diagnoses or the need for additional pulmonary medications, after assessment by a pulmonologist. Of particular interest was evaluating if FEF25-75% of predicted values less than 80% can be used as a marker for occult pulmonary disease in patients presenting with dysphonia.
RESULTS:

Of the 199 patient charts reviewed, 129 were female and 70 were male. The age of patients ranged from 18 to 88 years, with a mean of 46.8 years. The body mass index ranged from 17.5 to 53.4 kg/m2. One hundred five (52.8%) patients had FEF25-75% values less than 80% of predicted (poor midflow values). Of these patients, 76 (72.4%) were referred to a pulmonologist, 22 of 76 (28.9%) completed the referral, and 17 of 22 (77.3%) received a new pulmonary diagnosis or change in medications. Of the 155 patients without a history of pulmonary disease, 76 had poor midflow values, 57 (75%) of these patients were referred, and 12 of 57 (21%) completed the referral. Eight (67%) of these 12 patients were diagnosed with a previously unrecognized pulmonary disorder. Of the 44 patients with a prior history of pulmonary disease, 29 (65.9%) had poor midflow values. Nineteen (65.5%) of these patients were referred, and 9 (47%) received a new pulmonary diagnosis or a change in their medications. There were 51 classically trained singers and 148 nonclassically trained singers or nonsingers. There was no significant difference in average midflow values between the two groups (80.96 ± 24.7 and 80.73 ± 28.4, respectively) or in the percentage of classically trained singers with poor midflow values compared with nonsingers (53.5% vs. 49%, respectively).
CONCLUSION:

This study suggests that patients with dysphonia may have unrecognized underlying pulmonary disease, and PFT should be considered as part of the routine initial voice evaluation for patients presenting with dysphonia.

Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Dysphonia; Hoarseness; Pulmonary function tests; Voice; Voice evaluation
PMID: 29753445 DOI: 10.1016/j.jvoice.2018.01.008
[Indexed for MEDLINE]
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Select item 2973519717.
J Voice. 2019 Jul;33(4):580.e1-580.e9. doi: 10.1016/j.jvoice.2018.01.013. Epub 2018 May 4.
Effect of Parkinson Disease on Emotion Perception Using the Persian Affective Voices Test.
Saffarian A1, Shavaki YA1, Shahidi GA2, Jafari Z3.

Author information


Abstract

BACKGROUND AND OBJECTIVES:

Emotion perception plays a major role in proper communication with people in different social interactions. Nonverbal affect bursts can be used to evaluate vocal emotion perception. The present study was a preliminary step to establishing the psychometric properties of the Persian version of the Montreal Affective Voices (MAV) test, as well as to investigate the effect of Parkinson disease (PD) on vocal emotion perception.
METHODS:

The short, emotional sound made by pronouncing the vowel "a" in Persian was recorded by 22 actors and actresses to develop the Persian version of the MAV, the Persian Affective Voices (PAV), for emotions of happiness, sadness, pleasure, pain, anger, disgust, fear, surprise, and neutrality. The results of the recordings of five of the actresses and five of the actors who obtained the highest score were used to generate the test. For convergent validity assessment, the correlation between the PAV and a speech prosody comprehension test was examined using a gender- and age-matched control group. To investigate the effect of the PD on emotion perception, the PAV test was performed on 28 patients with mild PD between ages 50 and 70 years.
RESULTS:

The PAV showed a high internal consistency (Cronbach's α = 0.80). A significant positive correlation was observed between the PAV and the speech prosody comprehension test. The test-retest reliability also showed the high repeatability of the PAV (intraclass correlation coefficient = 0.815, P ≤ 0.001). A significant difference was observed between the patients with PD and the controls in all subtests.
CONCLUSION:

The PAV test is a useful psychometric tool for examining vocal emotion perception that can be used in both behavioral and neuroimaging studies.

Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Emotion perception; Nonverbal affect voices; Parkinson disease; Reliability; Validity
PMID: 29735197 DOI: 10.1016/j.jvoice.2018.01.013
[Indexed for MEDLINE]
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Select item 2973138018.
J Voice. 2019 Jul;33(4):453-464. doi: 10.1016/j.jvoice.2018.01.007. Epub 2018 May 3.
A Perceptual Method to Rate Dysphonic Voices.
Gurlekian JA1, Torres HM2, Cediel MR3.

Author information


Abstract

OBJECTIVE:

To present and test a production-matching method with external references, looking at the improvement of inter-rater variability of expert evaluations.
METHOD:

It consists of adjusting quality attribute levels of a synthetic vowel for a simultaneous matching with the natural patient vowel (NPV) attributes. In an initial experiment, seven speech-language pathology (SLP) experts performed this task with the new method and evaluated the same NPV with the standard method. Targets were twelve NPVs with a variety of quality attribute combinations. In a second experiment, we employed the proposed method to assess the evaluation performance of 65 SLP students.
RESULTS:

Expert evaluations show less dispersion for the proposed method than those obtained using the standard rating method. Student individual responses were compared with overall responses from their own group and were cross referenced with expert responses. A Kappa index is proposed as a measure of SLP students' performance.
CONCLUSIONS:

The proposed method was readily accepted by both SLP experts and students. Experts' consensus was improved. SLP students could benefit by quickly learning to discriminate complex attributes, which usually demands years of experience.

Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Dysphonic voice; Evaluation; Inter-rater variability; Matching; Production
PMID: 29731380 DOI: 10.1016/j.jvoice.2018.01.007
[Indexed for MEDLINE]
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Select item 2973137919.
J Voice. 2019 Jul;33(4):582.e1-582.e4. doi: 10.1016/j.jvoice.2018.02.005. Epub 2018 May 3.
Adaptation and Validation of the Kannada Singing Voice Handicap Index-10.
Gunjawate DR1, Aithal U V2, Bellur R2.

Author information


Abstract

OBJECTIVE:

The aim of the present study was to adapt and validate the English version of the Singing Voice Handicap Index-10 (SVHI-10) into Kannada language.
STUDY DESIGN:

Cross-sectional Comparitive study design.
METHODS:

The English version of SVHI-10 was translated into Kannada using standard procedure. A total of 115 singers participated in the study, including 90 singers with no voice problems (control group) and 25 singers with voice problems. The internal consistency, test-retest reliability, clinical validity, and cutoff points were calculated.
RESULTS:

Kannada SVHI-10 has excellent internal consistency and test-retest reliability. The singers with voice problems scored significantly higher than the singers with no voice problems (t = -14.67, df = 113, P < 0.001). The optimal cutoff point of the SVHI-10 was 9.5 with a sensitivity of 96% and specificity of 84%.
CONCLUSION:

The Kannada SVHI-10 is a reliable and clinically valid tool to assess the self-reported singing voice handicap among singers. It can also be used as a quick screening tool for distinguishing singers with and without voice problems as per client's perception.

Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Kannada; Quality of life; SVHI-10; Self-reported questionnaire; Voice
PMID: 29731379 DOI: 10.1016/j.jvoice.2018.02.005
[Indexed for MEDLINE]
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Select item 2973137720.
J Voice. 2019 Jul;33(4):497-500. doi: 10.1016/j.jvoice.2018.01.023. Epub 2018 May 3.
Acoustic Characteristics in Epiglottic Cyst.
Lee Y1, Kim G1, Wang S2, Jang J3, Cha W2, Choi H4, Kim H5.

Author information


Abstract

OBJECTIVE:

The purpose of this study was to analyze the acoustic characteristics associated with alternation deformation of the vocal tract due to large epiglottic cyst, and to confirm the relation between the anatomical change and resonant function of the vocal tract.
METHODS:

Eight men with epiglottic cyst were enrolled in this study. The jitter, shimmer, noise-to-harmonic ratio, and first two formants were analyzed in vowels /a:/, /e:/, /i:/, /o:/, and /u:/. These values were analyzed before and after laryngeal microsurgery.
RESULTS:

The F1 value of /a:/ was significantly raised after surgery. Significant differences of formant frequencies in other vowels, jitter, shimmer, and noise-to-harmonic ratio were not presented.
CONCLUSION:

The results of this study could be used to analyze changes in the resonance of vocal tracts due to the epiglottic cysts.

Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Epiglottic cyst; F1; F2; Formant; Jitter; Noise-to-harmonic ratio; Shimmer; Vocal tract; Vowel
PMID: 29731377 DOI: 10.1016/j.jvoice.2018.01.023
[Indexed for MEDLINE]
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Select item 2965033121.
J Voice. 2019 Jul;33(4):550-553. doi: 10.1016/j.jvoice.2018.01.002. Epub 2018 Apr 9.
Spasmodic Dysphonia in Multiple Sclerosis Treatment With Botulin Toxin A: A Pilot Study.
Di Stadio A1, Bernitsas E2, Restivo DA3, Alfonsi E4, Marchese-Ragona R5.

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Abstract

OBJECTIVES:

This study aims to evaluate the effect of botulin toxin A in patients with multiple sclerosis (MS) affected by spasmodic dysphonia (SD) and to show the safety and effectiveness of this treatment in long-term observation.
MATERIALS AND METHODS:

This is a pilot study on three relapsing-remitting MS patients with SD and their response to botulin toxin A.
RESULTS:

None of the patients reported dysphagia or other adverse events. Significant improvement was observed in terms of both voice quality and laryngostroboscopy results. The treatment effect was durable for 6-8 months.
CONCLUSIONS:

Botulin toxin A is a safe treatment that can be successfully used to treat SD in patients with MS. Larger studies are necessary to confirm our results.

Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Botulin toxin A; Dysphonia; Multiple sclerosis; Spasmodic dysphonia; Treatment
PMID: 29650331 DOI: 10.1016/j.jvoice.2018.01.002
[Indexed for MEDLINE]
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Select item 2963193822.
J Voice. 2019 Jul;33(4):583.e9-583.e14. doi: 10.1016/j.jvoice.2018.01.009. Epub 2018 Apr 6.
Distinct Acoustic Features and Glottal Changes Define Two Modes of Singing in Peking Opera.
Li G1, Li H2, Hou Q3, Jiang Z3.

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Abstract

OBJECTIVE:

We aimed to delineate the acoustic characteristics of the Laodan and Qingyi role in Peking Opera and define glottis closure states and mucosal wave changes during singing in the two roles.
METHODS:

The range of singing in A4 (440 Hz) pitch in seven female Peking Opera singers was determined using two classic pieces of Peking Opera. Glottal changes during singing were examined by stroboscopic laryngoscope. The fundamental frequency of /i/ in the first 15 seconds of the two pieces and the /i/ pitch range were determined. The relative length of the glottis fissure and the relative maximum mucosal amplitude were calculated.
RESULTS:

Qingyi had significantly higher mean fundamental frequency than Laodan. The long-term average spectrum showed an obvious formant cluster near 3000 Hz in Laodan versus Qingyi. No formant cluster was observed in singing in the regular mode. Strobe laryngoscopy showed complete glottal closure in Laodan and incomplete glottal closure in Qingyi in the maximal glottis closure phase. The relative length of the glottis fissure of Laodan was significantly lower than that of Qingyi in the singing mode. The relative maximum mucosal amplitude of Qingyi was significantly lower than that of Laodan.
CONCLUSION:

The Laodan role and the Qingyi role in Peking Opera sing in a fundamental frequency range compatible with the respective use of da sang (big voice) and xiao sang (small voice). The morphological patterns of glottal changes also indicate that the Laodan role and the Qingyi role sing with da sang and xiao sang, respectively.

Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Acoustic features; Da sang; Glottal changes; Peking opera; Xiao sang
PMID: 29631938 DOI: 10.1016/j.jvoice.2018.01.009
[Indexed for MEDLINE]
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Select item 2963193723.
J Voice. 2019 Jul;33(4):510-515. doi: 10.1016/j.jvoice.2017.12.016. Epub 2018 Apr 7.
The Nasal Musculature as a Control Panel for Singing-Why Classical Singers Use a Special Facial Expression?
Aura M1, Geneid A2, Bjørkøy K3, Rantanen M4, Laukkanen AM5.

Author information


Abstract

OBJECTIVES:

This study aimed to explain the possible reason why classical singers seem to spread their nostrils and raise their cheeks before starting to sing.
STUDY DESIGN:

This is an experimental study.
METHODS:

Five subjects (three classical singers, two nonsingers) were investigated with nasofiberoscopy holding their breath after inhalation. The subjects were instructed to have a neutral expression first and then to take the singers' expression characterized by nostril flaring. In case of nonsingers, the special expression was rehearsed beforehand, guided by a classical singer. The following measurements were made: (1) height of soft palate, (2) area of the hypopharynx, (3) area of the epilaryngeal tube inlet (Aditus laryngis), and (4) dimensions of the (visible) glottis (length, width, and length-to-width ratio).
RESULTS:

All subjects raised the palate and widened the pharyngeal inlet, epilaryngeal inlet, and the glottis during "singer's expression."
CONCLUSIONS:

The results suggest that classical singers may take advantage of breathing- and smelling-related connections between nasal and facial muscles and the larynx to avoid a hard glottal attack and pressed phonation and possibly also to assist the production of mixed register (head voice), characterized by a relatively low adduction between the vocal folds.

Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Classical singing; Control of airway resistance; Nose wing breathing; Nostril flaring; Singer's expression
PMID: 29631937 DOI: 10.1016/j.jvoice.2017.12.016
[Indexed for MEDLINE]
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Select item 2962572024.
J Voice. 2019 Jul;33(4):412-419. doi: 10.1016/j.jvoice.2018.02.001. Epub 2018 Apr 3.
A Computerized Tomography Study of Vocal Tract Setting in Hyperfunctional Dysphonia and in Belting.
Saldias M1, Guzman M2, Miranda G3, Laukkanen AM4.

Author information


Abstract

BACKGROUND:

Vocal tract setting in hyperfunctional patients is characterized by a high larynx and narrowing of the epilaryngeal and pharyngeal region. Similar observations have been made for various singing styles, eg, belting. The voice quality in belting has been described to be loud, speech like, and high pitched. It is also often described as sounding "pressed" or "tense". The above mentioned has led to the hypothesis that belting may be strenuous to the vocal folds. However, singers and teachers of belting do not regard belting as particularly strenuous.
PURPOSE:

This study investigates possible similarities and differences between hyperfunctional voice production and belting. This study concerns vocal tract setting.
METHODS:

Four male patients with hyperfunctional dysphonia and one male contemporary commercial music singer were registered with computerized tomography while phonating on [a:] in their habitual speaking pitch. Additionally, the singer used the pitch G4 in belting. The scannings were studied in sagittal and transversal dimensions by measuring lengths, widths, and areas.
RESULTS:

Various similarities were found between belting and hyperfunction: high vertical larynx position, small hypopharyngeal width, and epilaryngeal outlet. On the other hand, belting differed from dysphonia (in addition to higher pitch) by a wider lip and jaw opening, and larger volumes of the oral cavity.
CONCLUSIONS:

Belting takes advantage of "megaphone shape" of the vocal tract. Future studies should focus on modeling and simulation to address sound energy transfer. Also, they should consider aerodynamic variables and vocal fold vibration to evaluate the "price of decibels" in these phonation types.

Copyright © 2019. Published by Elsevier Inc.

KEYWORDS:

Computed tomography; Nonclassical singing; Physiology of singing; Vocal loading; Vocal tract imaging
PMID: 29625720 DOI: 10.1016/j.jvoice.2018.02.001
[Indexed for MEDLINE]
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Select item 2957387325.
J Voice. 2019 Jul;33(4):583.e1-583.e8. doi: 10.1016/j.jvoice.2018.02.010. Epub 2018 Mar 21.
CT-based Morphometric Analysis of Professional Opera Singers' Vocal Folds.
Clarós P1, Sobolewska AZ2, Doménech-Clarós A3, Clarós-Pujol A4, Pujol C4, Clarós A4.

Author information


Abstract

PURPOSE AND STUDY DESIGN:

Our work aimed to study the relationship between the length of vocal folds and classical voice type among professional opera singers. Also, the present paper attempts to assess if individual features such as height and body mass index are associated with the vocal folds length (VFL) and the vocal range. Our research compared VFL and voice type by evaluation of neck computed tomography imaging of professional opera singers obtained between 2009 and 2015. Vocal range was measured after scanning procedure by a speech-language pathologist. The results were used to compare VFL with vocal range, voice type, and individual features of every singer.
MATERIAL AND METHODS:

The group included 93 opera singers (female: 31 sopranos, 15 mezzos, and 5 contraltos; male: 17 tenors, 16 baritones, 6 basses, and 3 countertenors). Different values such as VFL, vocal range, and individuals' features (height, weight, body mass index) were analyzed statistically.
RESULTS:

Some significant differences and correlation were found. The VFL was diversified between classical voice types. VFL for soprano, mezzo-soprano, and bass was significantly different from every other type of voice. The vocal range has been shown to have a negative correlation with VFL value, which reflects the narrowest vocal range among bass voices. The analysis confirmed a linear correlation between VFL and individual features of the body such as height and body mass index.
CONCLUSION:

Presented data support the hypothesis that there are significant differences of VFL, vocal range, and body morphology between professional singers of different voice classification.

Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Computed tomography imaging; Opera singers; Professional singing; Vocal folds length; Voice classification
PMID: 29573873 DOI: 10.1016/j.jvoice.2018.02.010
[Indexed for MEDLINE]
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Select item 2957159826.
J Voice. 2019 Jul;33(4):584.e1-584.e4. doi: 10.1016/j.jvoice.2018.02.009. Epub 2018 Mar 20.
Behavioral Profile of Children With Vocal Fold Nodules-A Case-control Study.
Reis-Rego Â1, Santos PH2, Santos G3, Santos PC4, Dias D4, Vaz Freitas S5, Carvalho I4, Coutinho M4, Feliciano T4, Almeida C4.

Author information


Abstract

OBJECTIVES:

The aim of this case-control study was to evaluate the overall behavior of children with vocal fold nodules (VNs).
METHODS:

The study group included children with VNs between 4 and 15 years old diagnosed using fiberoptic video laryngoscopy with stroboscopy in a tertiary university hospital. As a control group, children between 4 and 13 years old without VNs, routinely followed up in a primary care facility, were included in the study. Parents of the participants completed the parent-proxy strengths and difficulties questionnaire (SDQ), a brief behavioral screening questionnaire designed for children. The SDQ evaluates emotional, conduct, and peer problems, and also focuses on hyperactivity and prosocial behavior. Children are classified into "normal," "borderline," or "abnormal" according to the total SDQ score.
RESULTS:

Twenty-seven children (24 boys and 3 girls) with VNs and 41 controls (33 boys and 8 girls) were enrolled in the study. The two groups did not differ significantly in age or gender (P > 0.05). Statistical analysis revealed that 52% individuals of the VNs group presents borderline or abnormal overall behavioral, which is statistically different from the general population (P < 0.001). Total, hyperactivity, and prosocial SDQ subscales were statistically different between study groups (P < 0.05).
CONCLUSIONS:

Our findings suggest association between VNs and hyperactivity and also with poorer prosocial behaviors in children for the first time. We propose that every child with VNs must be evaluated from a behavioral point of view to detect and to treat potential underlying psychological conditions that may interfere with VNs treatment and prognosis.

Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Behavior; Children; Hyperactivity; SDQ; Vocal fold nodules
PMID: 29571598 DOI: 10.1016/j.jvoice.2018.02.009
[Indexed for MEDLINE]
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Select item 2952507527.
J Voice. 2019 Jul;33(4):536-544. doi: 10.1016/j.jvoice.2018.01.024. Epub 2018 Mar 7.
Vocal Acoustic and Auditory-Perceptual Characteristics During Fluctuations in Estradiol Levels During the Menstrual Cycle: A Longitudinal Study.
Arruda P1, Diniz da Rosa MR2, Almeida LNA3, de Araujo Pernambuco L2, Almeida AA4.

Author information


Abstract


Estradiol production varies cyclically, changes in levels are hypothesized to affect the voice. The main objective of this study was to investigate vocal acoustic and auditory-perceptual characteristics during fluctuations in the levels of the hormone estradiol during the menstrual cycle. A total of 44 volunteers aged between 18 and 45 were selected. Of these, 27 women with regular menstrual cycles comprised the test group (TG) and 17 combined oral contraceptive users comprised the control group (CG). The study was performed in two phases. In phase 1, anamnesis was performed. Subsequently, the TG underwent blood sample collection for measurement of estradiol levels and voice recording for later acoustic and auditory-perceptual analysis. The CG underwent only voice recording. Phase 2 involved the same measurements as phase 1 for each group. Variables were evaluated using descriptive and inferential analysis to compare groups and phases and to determine relationships between variables. Voice changes were found during the menstrual cycle, and such changes were determined to be related to variations in estradiol levels. Impaired voice quality was observed to be associated with decreased levels of estradiol. The CG did not demonstrate significant vocal changes during phases 1 and 2. The TG showed significant increases in vocal parameters of roughness, tension, and instability during phase 2 (the period of low estradiol levels) when compared with the CG. Low estradiol levels were also found to be negatively correlated with the parameters of tension, instability, and jitter and positively correlated with fundamental voice frequency.

Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Estradiol; Estrogen; Hormones; Menstrual cycle; Voice
PMID: 29525075 DOI: 10.1016/j.jvoice.2018.01.024
[Indexed for MEDLINE]
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Select item 2947870828.
J Voice. 2019 Jul;33(4):501-509. doi: 10.1016/j.jvoice.2018.01.012. Epub 2018 Feb 22.
Emotion Recognition From Singing Voices Using Contemporary Commercial Music and Classical Styles.
Hakanpää T1, Waaramaa T2, Laukkanen AM3.

Author information


Abstract

OBJECTIVES:

This study examines the recognition of emotion in contemporary commercial music (CCM) and classical styles of singing. This information may be useful in improving the training of interpretation in singing.
STUDY DESIGN:

This is an experimental comparative study.
METHODS:

Thirteen singers (11 female, 2 male) with a minimum of 3 years' professional-level singing studies (in CCM or classical technique or both) participated. They sang at three pitches (females: a, e1, a1, males: one octave lower) expressing anger, sadness, joy, tenderness, and a neutral state. Twenty-nine listeners listened to 312 short (0.63- to 4.8-second) voice samples, 135 of which were sung using a classical singing technique and 165 of which were sung in a CCM style. The listeners were asked which emotion they heard. Activity and valence were derived from the chosen emotions.
RESULTS:

The percentage of correct recognitions out of all the answers in the listening test (N = 9048) was 30.2%. The recognition percentage for the CCM-style singing technique was higher (34.5%) than for the classical-style technique (24.5%). Valence and activation were better perceived than the emotions themselves, and activity was better recognized than valence. A higher pitch was more likely to be perceived as joy or anger, and a lower pitch as sorrow. Both valence and activation were better recognized in the female CCM samples than in the other samples.
CONCLUSIONS:

There are statistically significant differences in the recognition of emotions between classical and CCM styles of singing. Furthermore, in the singing voice, pitch affects the perception of emotions, and valence and activity are more easily recognized than emotions.

Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Emotion expression; Perception; Singing style; Song genre; Voice quality
PMID: 29478708 DOI: 10.1016/j.jvoice.2018.01.012
[Indexed for MEDLINE]
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Select item 2947215029.
J Voice. 2019 Jul;33(4):575-579. doi: 10.1016/j.jvoice.2018.01.011. Epub 2018 Feb 19.
Cost Analysis of Channeled, Distal Chip Laryngoscope for In-office Laryngopharyngeal Biopsies.
Marcus S1, Timen M1, Dion GR1, Fritz MA1, Branski RC2, Amin MR1.

Author information


Abstract

OBJECTIVE:

Given that financial considerations play an increasingly prominent role in clinical decision-making, we sought (1) to determine the cost-effectiveness of in-office biopsy for the patient, the provider, and the health-care system, and (2) to determine the diagnostic accuracy of in-office biopsy.
STUDY DESIGN:

Retrospective, financial analyses were performed.
METHODS:

Patients who underwent in-office (Current Procedural Terminology Code 31576) or operative biopsy (CPT Code 31535) for laryngopharyngeal lesions were included. Two financial analyses were performed: (1) the average cost of operating room (OR) versus in-office biopsy was calculated, and (2) a break-even analysis was calculated to determine the cost-effectiveness of in-office biopsy for the provider. In addition, the diagnostic accuracy of in-office biopsies and need for additional biopsies or procedures was recorded.
RESULTS:

Of the 48 patients included in the current study, 28 underwent in-office biopsy. A pathologic sample was obtained in 26 of 28 (92.9%) biopsies performed in the office. Of these patients, 16 avoided subsequent OR procedures. The average per patient cost was $7000 and $11,000 for in-office and OR biopsy, respectively. Break-even analysis demonstrated that the provider could achieve a profit 2 years after purchase of the necessary equipment.
CONCLUSION:

In-office laryngopharyngeal biopsies are accurate and, overall, more cost-effective than OR biopsies. Purchase of the channeled, distal chip laryngoscope and biopsy forceps to perform in-office biopsies can be profitable for a provider with a videolaryngoscopy tower. In-office biopsy should be considered the initial diagnostic tool for suspected laryngopharyngeal malignancies noted on videolaryngoscopy.

Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Cost-effectiveness; Laryngopharyngeal lesion; Malignancy; Office-based biopsy; Voice
PMID: 29472150 DOI: 10.1016/j.jvoice.2018.01.011
[Indexed for MEDLINE]
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MeSH terms


Select item 2947214930.
J Voice. 2019 Jul;33(4):580.e11-580.e19. doi: 10.1016/j.jvoice.2018.01.016. Epub 2018 Feb 19.
The Effect of Parkinson Disease Tremor Phenotype on Cepstral Peak Prominence and Transglottal Airflow in Vowels and Speech.
Burk BR1, Watts CR2.

Author information


Abstract

OBJECTIVES:

The physiological manifestations of Parkinson disease are heterogeneous, as evidenced by disease subtypes. Dysphonia has been well documented as an early and progressively significant impairment associated with the disease. The purpose of this study was to investigate how acoustic and aerodynamic measures of vocal function were affected by Parkinson tremor subtype (phenotype) in an effort to better understand the heterogeneity of voice impairment severity in Parkinson disease.
STUDY DESIGN:

This is a prospective case-control study.
METHODS:

Thirty-two speakers with Parkinson disease assigned to tremor and nontremor phenotypes and 10 healthy controls were recruited. Sustained vowels and connected speech were recorded from each speaker. Acoustic measures of cepstral peak prominence (CPP) and aerodynamic measures of transglottal airflow (TAF) were calculated from the recorded acoustic and aerodynamic waveforms.
RESULTS:

Speakers with a nontremor dominant phenotype exhibited significantly (P < 0.05) lower CPP and higher TAF in vowels compared with the tremor dominant phenotype and control speakers, who were not different from each other. No significant group differences were observed for CPP or TAF in connected speech.
CONCLUSIONS:

When producing vowels, participants with nontremor dominant phenotype exhibited reduced phonation periodicity and elevated TAF compared with tremor dominant and control participants. This finding is consistent with differential limb-motor and cognitive impairments between tremor and nontremor phenotypes reported in the extant literature. Results suggest that sustained vowel production may be sensitive to phonatory control as a function of Parkinson tremor phenotype in mild to moderate stages of the disease.

Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Acoustic analysis; Cepstral peak prominence; Dysphonia; Parkinson disease; Transglottal airflow
PMID: 29472149 DOI: 10.1016/j.jvoice.2018.01.016
[Indexed for MEDLINE]
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Select item 2945455231.
J Voice. 2019 Jul;33(4):482-489. doi: 10.1016/j.jvoice.2018.01.018. Epub 2018 Feb 14.
Adjustment of the Vocal Tract Shape via Biofeedback: A Case Study.
Hoyer P1, Graf S2.

Author information


Abstract


In this study, an adjustment of the vocal tract shape toward selected sound waves in the frequency range of the first and second formants without phonation is discussed. The sound waves of a loudspeaker in front of the open mouth and amplified by the vocal tract are used as biofeedback signals. It is shown that the resonance amplification of the vocal tract complies with the concept of forced oscillation, with the driver being the sound source and the resonator being the vocal tract. An adjustment toward increased amplification via vocal tract resonance can be related to smaller bandwidths and lower damping. Furthermore, the applied adjustment frequencies are preserved as vocal tract resonances during exhalation and even phonation. This novel form of biofeedback might enrich standard voice training procedures by exercises without phonation.

Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Bandwidths; Biofeedback; Formants; Vocal tract; Voice training
PMID: 29454552 DOI: 10.1016/j.jvoice.2018.01.018
[Indexed for MEDLINE]
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Select item 2944906332.
J Voice. 2019 Jul;33(4):581.e1-581.e6. doi: 10.1016/j.jvoice.2017.12.001. Epub 2018 Feb 12.
Comparison of Post-therapy Dysphonic Voices and Normal Voices.
Schaeffer N1, Fuse A2.

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Abstract

PURPOSE:

The purpose of the present investigation was to compare the voices of post-therapy dysphonic participants with participants who have normal voices to determine how close the corrected voices approached normal vocal levels. The present investigation is a follow-up to the authors' previous research in which dysphonic participants, with voices ranging from moderate-to-severe dysphonia, were evaluated pre- and post therapy using the Dysphonic Severity Percentage scale and the interval scale.
METHODS:

In the present study, five raters, three speech-language pathologists experienced in assessing dysphonia, and two trained speech-language pathology college students evaluated 20 participants with normal voices under the same two conditions as those of the corrected participants-when reading a paragraph aloud and during spontaneous speech. While listening to the recordings of the normal voices, the raters tallied any dysphonic syllables produced by the participants to obtain a Dysphonic Severity Percentage for both paragraph reading and spontaneous speech. The raters also evaluated the normal voices on the interval scale. These data were compared with those of the post-therapy participants, who were evaluated under the same conditions and methods pre- and post therapy.
RESULTS AND CONCLUSION:

The dysphonic participants' voices improved significantly post therapy in comparison with their pretherapy result; their improvement, however, was not commensurate with the voices of the normal participants, and the data showed a significant difference between the two groups. Both evaluation scales reflected a high agreement among raters.

Copyright © 2019. Published by Elsevier Inc.

KEYWORDS:

Dysphonic Severity Percentage (DSP); Experienced raters; Interval scale; Participants with normal voices; Post dysphonic participants
PMID: 29449063 DOI: 10.1016/j.jvoice.2017.12.001
[Indexed for MEDLINE]
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Select item 2942827433.
J Voice. 2019 Jul;33(4):385-400. doi: 10.1016/j.jvoice.2018.01.001. Epub 2018 Feb 7.
Computational Models of Laryngeal Aerodynamics: Potentials and Numerical Costs.
Sadeghi H1, Kniesburges S2, Kaltenbacher M3, Schützenberger A2, Döllinger M2.

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Abstract


Human phonation is based on the interaction between tracheal airflow and laryngeal dynamics. This fluid-structure interaction is based on the energy exchange between airflow and vocal folds. Major challenges in analyzing the phonatory process in-vivo are the small dimensions and the poor accessibility of the region of interest. For improved analysis of the phonatory process, numerical simulations of the airflow and the vocal fold dynamics have been suggested. Even though most of the models reproduced the phonatory process fairly well, development of comprehensive larynx models is still a subject of research. In the context of clinical application, physiological accuracy and computational model efficiency are of great interest. In this study, a simple numerical larynx model is introduced that incorporates the laryngeal fluid flow. It is based on a synthetic experimental model with silicone vocal folds. The degree of realism was successively increased in separate computational models and each model was simulated for 10 oscillation cycles. Results show that relevant features of the laryngeal flow field, such as glottal jet deflection, develop even when applying rather simple static models with oscillating flow rates. Including further phonatory components such as vocal fold motion, mucosal wave propagation, and ventricular folds, the simulations show phonatory key features like intraglottal flow separation and increased flow rate in presence of ventricular folds. The simulation time on 100 CPU cores ranged between 25 and 290 hours, currently restricting clinical application of these models. Nevertheless, results show high potential of numerical simulations for better understanding of phonatory process.

Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Computational cost; Glottal aerodynamics; Human phonation; Large eddy simulation; Numerical larynx model
PMID: 29428274 DOI: 10.1016/j.jvoice.2018.01.001
[Indexed for MEDLINE]
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Select item 2942237134.
J Voice. 2019 Jul;33(4):420-428. doi: 10.1016/j.jvoice.2017.12.019. Epub 2018 Feb 13.
Comparing the Exposure-Response Relationships of Physiological and Traditional Vocal Warm-ups on Aerodynamic and Acoustic Parameters in Untrained Singers.
Kang J1, Xue C1, Chou A2, Scholp A2, Gong T1, Zhang Y1, Chen Z1, Jiang JJ3.

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Abstract

OBJECTIVES:

The aim of this study was to quantify the effects of traditional and physiological warm-up exercises and to determine the optimal duration of these methods using acoustic and aerodynamic metrics.
METHODS:

Twenty-six subjects were recruited to participate in both straw phonation exercises (physiological vocal warm-up) and traditional singing exercises (traditional vocal warm-up) for 20 minutes each, 24 hours apart. Phonation threshold pressure (PTP), fundamental frequency, jitter, shimmer, and noise-to-harmonics ratio were measured before the intervention (m0), as well as after 5 minutes (m5), 10 minutes (m10), 15 minutes (m15), and 20 minutes (m20) of intervention.
RESULTS:

PTP decreased significantly after straw phonation and reached a minimum value at 10 minutes (P < 0.001) and remained stable in traditional singing exercises. There were significant differences in fundamental frequency and shimmer from m0 to m15 and m20 in the traditional singing group (P = 0.001, P = 0.001, P = 0.001, and P = 0.002, respectively). No significant changes in acoustic parameters were observed after straw phonation.
CONCLUSIONS:

Both straw phonation exercises and traditional singing exercises are effective for voice warm-up. Straw phonation improves the subjects' fatigue resistance and vocal economy, resulting in a reduced PTP, whereas traditional singing exercises focus on technical singing skills, leading to an improvement of acoustic variables.

Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Acoustics; Aerodynamics; Semioccluded vocal tract; Straw phonation; Vocal warm-up
PMID: 29422371 DOI: 10.1016/j.jvoice.2017.12.019
[Indexed for MEDLINE]
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Select item 2940251135.
J Voice. 2019 Jul;33(4):441-444. doi: 10.1016/j.jvoice.2018.01.010. Epub 2018 May 7.
Cross-cultural Adaption and Validation of the Danish Voice Handicap Index.
Sorensen JR1, Printz T2, Mehlum CS2, Heidemann CH3, Groentved AM2, Godballe C2.

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Abstract

OBJECTIVES:

We aimed to assess psychometric properties, including internal consistency, reliability, and clinical validity of the Danish version of the Voice Handicap Index (VHI).
STUDY DESIGN:

A cross-sectional survey study was carried out.
METHODS:

For validation, the existing nonvalidated Danish version of the VHI was used. Data from 208 patients with voice disorders of different etiology (neurogenic, functional, and structural) and a control group of 85 vocally healthy individuals were included. A test-retest reliability analysis of 42 patients and 45 control persons was performed. The internal consistency, test-retest reliability, and clinical validity of the questionnaire were assessed.
RESULTS:

Internal consistency was high with a Cronbach α >0.90 for both the patient and control group. Test-retest reliability measured as intraclass correlation coefficient was good with 0.93 (95% confidence interval [95% confidence interval]: 0.87-0.96) for patients and 0.78 (95% confidence interval: 0.63-0.87) for the control group which indicates sufficient reliability of the questionnaire. The Danish VHI has good clinical validity as it has a strong correlation between patient's perception of the severity of their voice disorder and the VHI score from the Spearman correlation of 0.69.
CONCLUSION:

The existing Danish version of the VHI has been thoroughly validated and found to be in line with the original VHI from Jacobsen et al. It showed good internal consistency, test-retest reliability, and clinical validity. It is suitable for use in daily practice and in research projects as it is able to assess patients' perception of their voice disorder severity.

Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Danish; Dysphonia; Reliability; Validity; Voice Handicap Index
PMID: 29402511 DOI: 10.1016/j.jvoice.2018.01.010
[Indexed for MEDLINE]
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Select item 2939533236.
J Voice. 2019 Jul;33(4):526-535. doi: 10.1016/j.jvoice.2017.12.010. Epub 2018 Feb 1.
Voice Tremor in Parkinson's Disease: An Acoustic Study.
Gillivan-Murphy P1, Miller N2, Carding P3.

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Abstract

BACKGROUND:

Voice tremor associated with Parkinson disease (PD) has not been characterized. Its relationship with voice disability and disease variables is unknown.
OBJECTIVES:

This study aimed to evaluate voice tremor in people with PD (pwPD) and a matched control group using acoustic analysis, and to examine correlations with voice disability and disease variables.
METHODS:

Acoustic voice tremor analysis was completed on 30 pwPD and 28 age-gender matched controls. Voice disability (Voice Handicap Index), and disease variables of disease duration, Activities of Daily Living (Unified Parkinson's Disease Rating Scale [UPDRS II]), and motor symptoms related to PD (UPDRS III) were examined for relationship with voice tremor measures.
RESULTS:

Voice tremor was detected acoustically in pwPD and controls with similar frequency. PwPD had a statistically significantly higher rate of amplitude tremor (Hz) than controls (P = 0.001). Rate of amplitude tremor was negatively and significantly correlated with UPDRS III total score (rho -0.509). For pwPD, the magnitude and periodicity of acoustic tremor was higher than for controls without statistical significance. The magnitude of frequency tremor (Mftr%) was positively and significantly correlated with disease duration (rho 0.463). PwPD had higher Voice Handicap Index total, functional, emotional, and physical subscale scores than matched controls (P < 0.001). Voice disability did not correlate significantly with acoustic voice tremor measures.
CONCLUSION:

Acoustic analysis enhances understanding of PD voice tremor characteristics, its pathophysiology, and its relationship with voice disability and disease symptomatology.

Copyright © 2018 The Voice Foundation. All rights reserved.

KEYWORDS:

Acoustic analysis; Disease variables; Parkinson disease; Voice disability; Voice tremor

Comment in
Letter to the Editor Regarding "Voice Tremor in Parkinson's Disease: An Acoustic Study" by Gillivan-Murphy et al, In Press in Journal of Voice. [J Voice. 2019]
PMID: 29395332 DOI: 10.1016/j.jvoice.2017.12.010
[Indexed for MEDLINE]
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Select item 2939533037.
J Voice. 2019 Jul;33(4):554-560. doi: 10.1016/j.jvoice.2017.12.011. Epub 2018 Feb 1.
Efficacy of Two-dimensional Scanning Digital Kymography in Evaluation of Atrophic Vocal Folds.
Bae IH1, Wang SG2, Lee JC3, Sung ES2, Kim ST4, Lee YW5, Kang DH6, Wang YJ7.

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Abstract

OBJECTIVE:

The purpose of this study was to evaluate the clinical feasibility and diagnostic accuracy of two-dimensional scanning digital kymography (2D DKG) in patients with vocal cord atrophy before and after treatment.
MATERIALS AND METHODS:

We analyzed the characteristics of vocal fold vibration in five patients with unilateral vocal fold paralysis and five patients with presbyphonia. In patients with vocal cord paralysis, the status before and after intracordal injection was compared. Furthermore, in patients with presbyphonia, we compared the status before and after voice therapy (Seong-Tae Kim's laryngeal calibration technique). Quantitative parameters such as amplitude and phase symmetry indices, jitter, shimmer, noise-to-harmonic ratio, and maximum phonation time and qualitative parameters such as Voice Handicap Index, glottal gap, amplitude, and phase difference were used to evaluate the pre- and post-treatment status.
RESULTS:

In cases of vocal cord paralysis, vibratory changes of the vocal folds before and after intracordal injection could be identified immediately using 2D DKG. In overcorrection cases, all of the measured parameters were poor except for improvement of the glottal gap. In addition, 2D DKG showed appropriately the changes in vocal cord vibration before and after voice therapy in patients with presbyphonia.
CONCLUSION:

Two-dimensional DKG may be a useful diagnostic tool in evaluation of the vibratory characteristics of entire vocal cords. In addition, it may also play a role in providing a decision for treatment modalities.

Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Atrophy; Paralysis; Presbyphonia; Two-dimensional scanning digital kymography; Vocal cord
PMID: 29395330 DOI: 10.1016/j.jvoice.2017.12.011
[Indexed for MEDLINE]
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Select item 2936133838.
J Voice. 2019 Jul;33(4):545-549. doi: 10.1016/j.jvoice.2017.12.012. Epub 2018 Feb 1.
Voice Tremor Outcomes of Subthalamic Nucleus and Zona Incerta Deep Brain Stimulation in Patients With Parkinson Disease.
Karlsson F1, Malinova E2, Olofsson K3, Blomstedt P4, Linder J4, Nordh E4.

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Abstract

OBJECTIVES:

We aimed to study the effect of deep brain stimulation (DBS) in the subthalamic nucleus (STN) and caudal zona incerta (cZi) on level of perceived voice tremor in patients with Parkinson disease (PD).
STUDY DESIGN:

This is a prospective nonrandomized design with consecutive patients.
METHODS:

Perceived voice tremor was assessed in patients with PD having received either STN-DBS (8 patients, 5 bilateral and 3 unilateral, aged 43.1-73.6 years; median = 61.2 years) or cZi-DBS (14 bilateral patients, aged 39.0-71.9 years; median = 56.6 years) 12 months before the assessment. Sustained vowels that were produced OFF and ON stimulation (with simultaneous l-DOPA medication) were assessed perceptually in terms of voice tremor by two raters on a four-point rating scale. The assessments were repeated five times per sample and rated in a blinded and randomized procedure.
RESULTS:

Three out of the 22 patients (13%) were concluded to have voice tremor OFF stimulation. Patients with PD with STN-DBS showed mild levels of perceived voice tremor OFF stimulation and a group level improvement. Patients with moderate/severe perceived voice tremor and cZi-DBS showed marked improvements, but there was no overall group effect. Six patients with cZi-DBS showed small increases in perceived voice tremor severity.
CONCLUSIONS:

STN-DBS decreased perceived voice tremor on a group level. cZi-DBS decreased perceived voice tremor in patients with PD with moderate to severe preoperative levels of the symptom.

Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

DBS; Parkinson disease; STN; Voice tremor; cZi
PMID: 29361338 DOI: 10.1016/j.jvoice.2017.12.012
[Indexed for MEDLINE]
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Select item 2931088539.
J Voice. 2019 Jul;33(4):429-434. doi: 10.1016/j.jvoice.2017.11.019. Epub 2018 Jan 5.
Characteristics of a Treatment-seeking Population in a Private Practice Community Voice Clinic: An Epidemiologic Study.
Watts CR1, Knickerbocker K2.

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Abstract

OBJECTIVE:

The purpose of this study was to evaluate epidemiologic characteristics of a treatment-seeking population referred to a private practice community voice clinic.
STUDY DESIGN:

This is a retrospective cohort study.
METHODS:

Patient files representing evaluation referrals over a 28-month period were reviewed. Variables tabulated from records included disorder diagnosis, age, gender, perceptual voice quality ratings, and self-perceived voice handicap at initial evaluation. Descriptive statistics were used to evaluate the diagnosis category and demographic patterns. Parametric statistics were applied to quantitative clinical measurements to test the effect of voice disorder category on perceptual voice quality ratings and self-perceived voice handicap.
RESULTS:

A total of 216 consecutive patient files were reviewed. Collectively, the most common disorder diagnosis was "other," consisting of a varied cluster of etiologies, including reflux laryngitis, chronic cough, bilateral paralysis or paresis, leukoplakia, and polypoid degeneration. The most common diagnosis in women was midmembranous lesions, and that in men was the "other" category followed by atrophy and bowing associated with presbylaryngis. The greatest severity and handicap measures were found in patients with unilateral paralysis.
CONCLUSIONS:

Collectively, the demographic patterns reported in this study align with those from specialty voice clinics housed in academic medical centers and community voice clinics led by laryngologists and general otolaryngologists. Translating these findings to professional practice, the data support the notion that speech-language pathologists specializing as voice therapists who seek to establish private practice clinics should possess competencies in the knowledge and skills required to serve treatment-seeking populations with a wide variety of voice impairments.

Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Dysphonia; Epidemiology; Otolaryngology; Private practice; Voice disorder
PMID: 29310885 DOI: 10.1016/j.jvoice.2017.11.019
[Indexed for MEDLINE]
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