Screen11: validating a screening instrument for voice disorders in accordance with the COSMIN framework.

PURPOSE: Although numerous patient-reported outcome measures have been developed and validated to quantify the impact of voice problems on different aspects of life, to our knowledge no screening instrument exists that specifically captures voice disorders in a retrospective fashion. The aim of the present study was to examine the psychometric properties and diagnostic validity of a retrospective voice screening method, Screen11, according to the COSMIN framework for health-related, patient-reported outcome measures. The items in Screen11 have been used to establish the prevalence of voice disorders in both general and occupation-specific populations in the Nordic countries. However, the instrument has not been validated. METHODS: The voice patient group (n = 54) in this study comprised of patients from the Turku University Central Hospital phoniatric outpatient clinic seeking help for their voice problems. For these voice patients, we recruited voice-healthy controls (n = 61) who matched in terms of gender, age, and occupation. The participants responded to the Screen11 questionnaire along with the VHI and the VAPP. RESULTS: The results of the initial exploratory factor analysis showed that all the Screen11 items loaded on a common underlying latent factor. Furthermore, Screen11 had high internal consistency (α = .93) and correlated sufficiently with other voice questionnaires. CONCLUSIONS: The results indicate that Screen11, which screens for possible voice disorders at an early stage, was successfully validated. With respect to its diagnostic validity, the Screen11 sum score is preferable. A threshold of ≥ 15 should be used for differentiating patients with possible voice disorders from those with healthy voices.

Acoustic Voice Quality Index as a Potential Tool for Voice Screening.

INTRODUCTION: To diminish the risk of voice disorders in people who are highly dependent on their voices, such as teachers, vocal screening is important already at the beginning of such individuals' professional studies. A reliable, specified screening tool is needed. The Acoustic Voice Quality Index (AVQI) has been found to differentiate normal voices from abnormal voices and to serve as a treatment outcome measure. This study investigated whether AVQI could be a screening tool in combination with auditory- and self-perception of the voice to discriminate normal from slightly poor voices. TYPE OF STUDY: Experimental. METHODS: Some 128 female teaching students (mean age 26.39 years, SD 9.80 years) with no diagnosed voice disorders participated in this study. They read aloud a text in Finnish, sustained the vowel /a:/, and filled the Voice Handicap Index (VHI) questionnaire. Voice samples were recorded with an AKG C544L headset microphone, iFocusrite soundcard, and Praat software using a 44100 sample rate and 16-bit amplitude quantization. Five expert voice therapists evaluated the samples to determine the grade of dysphonia (G) using a scale of 0-0.5 (=normal), 0.5-1 (=mild), 1-2 (=moderate), and 2-3 (=severe). Three medial seconds of [a:] and the first 31 syllables of the text were analyzed using AVQI script version 03.01 in Praat (5.3.55). The analysis gives one AVQI score per participant (scale 0-10). The AVQI threshold of normal and disordered voices for Finnish speakers is 1.83; a Gmean = 0.0-0.5 and VHI score <19 were considered normal. Statistical analysis was done using the receiver operating characteristic (ROC) curve, Spearman's correlation coefficient, and the independent samples t test. RESULTS: According to the AVQI results, the area under the curve (AROC) was 0.554, which is fair. The Youden index gave a cutoff value of 0.30 with a sensitivity of 85% and a specificity of 81.1%. There were weak but significant correlations between Gmean and AVQI and two AVQI parameters, smoothed cepstral peak prominence and harmonic-to-noise ratio (r = 0.27; --0.24; -0.20, respectively; |P < 0.05); and between total VHI and AVQI score and cepstral peak prominence (r = 0.21; 0.20, respectively; P < 0.05). Furthermore, the AVQI scores differed significantly between the groups with a VHI total score <19 and ≥19. CONCLUSIONS: AVQI did not differentiate between voices that had been perceptually judged as normal or slightly abnormal, but a combination of perceptual assessment in the form of AVQI and VHI could better screen slightly deviant voices.

Investigating the Role of Salivary Cortisol on Vocal Symptoms.

Purpose: We investigated whether participants who reported more often occurring vocal symptoms showed higher salivary cortisol levels and if such possible associations were different for men and women. Method: The participants (N = 170; men n = 49, women n = 121) consisted of a population-based sample of Finnish twins born between 1961 and 1989. The participants submitted saliva samples for hormone analysis and completed a web questionnaire including questions regarding the occurrence of 6 vocal symptoms during the past 12 months. The data were analyzed using the generalized estimated equations method. Results: A composite variable of the vocal symptoms showed a significant positive association with salivary cortisol levels (p < .001). Three of the 6 vocal symptoms were significantly associated with the level of cortisol when analyzed separately (p values less than .05). The results showed no gender difference regarding the effect of salivary cortisol on vocal symptoms. Conclusions: There was a positive association between the occurrence of vocal symptoms and salivary cortisol levels. Participants with higher cortisol levels reported more often occurring vocal symptoms. This could have a connection to the influence of stress on vocal symptoms because stress is a known risk factor of vocal symptoms and salivary cortisol can be seen as a biomarker for stress.

Associations Between Vocal Symptoms and Genetic Variants in the Oxytocin Receptor and Arginine Vasopressin 1A Receptor Gene.

Purpose: Oxytocin and arginine vasopressin are associated with different aspects of the stress response. As stress is regarded as a risk factor for vocal symptoms, we wanted to explore the association between the oxytocin receptor gene (OXTR) and arginine vasopressin 1A receptor gene (AVPR1A) single-nucleotide polymorphisms (SNPs) and vocal symptoms. We also wanted to explore whether such effects might be mediated by cortisol because oxytocin and vasopressin are associated with cortisol levels. Method: A population-based sample (N = 657) of Finnish twins (born 1961-1989) completed a web questionnaire on the occurrence of vocal symptoms. A total of 170 participants submitted saliva samples for hormone analysis. A total of 20 OXTR and AVPR1A SNPs were analyzed. Results: Three OXTR polymorphisms (rs2270465, rs2268493, rs7632287) and 2 AVPR1A polymorphisms (rs1587097, rs1042615) showed nominal effects (p < .05) on vocal symptoms, of which 1 (rs1587097) remained significant after correcting for multiple testing (p = .003). We found potential mediation of the effect of the OXTR rs2268493 polymorphism on vocal symptoms through levels of cortisol. Conclusions: The associations between variants of OXTR and AVPR1A and vocal symptoms indicate that oxytocin and vasopressin might influence vocal symptoms. The effect of oxytocin seems to be partly mediated through cortisol actions.