The Patient Experience: The Relationship Between Vocal Handicap, Congruency, Perceived Present Control, and Mood Across Four Voice Disorders.

The potential for negative sequalae in psychosocial well-being presents clinical importance to the assessment of voice disorders. Despite the impairment voice disorders cause in the psychosocial domain, the clinical assessment of these disorders relies heavily on visual perceptual judgments of the larynx, audio-perceptual, as well as acoustic and aerodynamic measures. While these measures aid in accurate diagnosis and are necessary for standard of care, they present little insight into the patient experience of having a voice disorder. DESIGN: Retrospective between-subject, non-experimental design. METHODS: Data from 335 patients from the University of Pittsburgh Voice Center were collected from scores of the Voice Handicap Index-10 (VHI-10) and two recent questionnaires, the Voice Present Perceived Control scale (VPPC), and the Vocal Congruency Scale (VCS). Examining how these voice-specific scales related to three mental health screeners for stress (Perceived Stress Scale-4), anxiety (Generalized Anxiety Disorder-7) and depression (Patient Health Questionnaire-9) were also examined. Patient diagnoses included primary muscle tension dysphonia (pMTD), unilateral vocal fold paralysis (UVFP), vocal fold atrophy, and mid membranous vocal fold lesions. RESULTS: There were significant differences in scores from the voice-specific scales between diagnostic groups with UVFP being the highest (worst) in VHI-10 and UVFP being the lowest (worst) in VCS compared to healthy controls. There was no significant difference in VPPC scores between diagnostic groups. Results showed statistically significant inverse relationships between the VHI-10 and the VPPC and between the VHI-10 and VCS for all diagnostic groups. A significant direct relationship was found between the VPPC and the VCS for patients diagnosed with MTD, UVFP and Lesions. In sum, patients with UVFP presented with the most frequent and sometimes strongest relationships between voice and mental health measures. DISCUSSION: This study marks an initial investigation into the nuanced patient experience of having a voice disorder. Three theoretically unrelated voice constructs: handicap, perceived control, and sense of self, were measured via self-report. Results from this study describe the patient experience correlating to these constructs with weak correlations to stress, anxiety, and depression. Findings also clearly suggest that patient experience varies among diagnostic groups, as well as varying constructs. Measures of multiple constructs of patient perception provide valuable insight into a patient's experience of their voice disorder, guidance on the direction of voice treatment, and justification for such treatments.

An Examination of Pre- and Posttreatment Acoustic Versus Auditory Perceptual Analyses of Voice Across Four Common Voice Disorders.

OBJECTIVE: The objective, instrumental acoustic measure of Cepstral Spectral Index of Dysphonia (CSID) correlates with audio-perceptual measures, is sensitive in detecting voice abnormalities, and tracks change following treatment. The goals of the current study were to (1) test the agreement between CSID versus auditory perceptual measures of pre- versus posttreatment voice change, and (2) investigate whether change in scores is based on voice disorder or phonemic structure of sentence stimuli. METHODS: Forty patients with benign voice disorders produced sentences and a sustained /a/ vowel from the Consensus Auditory Perceptual Evaluation of Voice protocol before and after treatment. CSID was calculated, and overall audio-perceptual voice severity was judged by 7 blinded, trained raters using a 100-mm visual analog scale. Differences between CSID and audio-perceptual measures of voice change across voice disorder and stimuli, and correlation between change in CSID and perceptual rating scores were assessed pre- and postintervention. RESULTS: Across all subjects, there were significant correlations between CSID and perceptual ratings change scores (P < 0.001), and no significant differences in pre- and posttreatment change. Disorder-specific analyses indicated that all tested sentence/vowel contexts are effective measures for pre- versus posttreatment change in atrophy and paralysis cases. Acoustic versus perceptual measures of voice change were significantly correlated in lesion cases for the sentence "How hard did he hit him" and with all sentences combined. There were no significant findings observed for muscle tension dysphonia. CONCLUSION: CSID provides an accurate objective correlate to auditory-perceptual posttreatment change in overall voice severity ratings. Implications for outcomes testing and disorder-specific findings are discussed.

Adult normative data for phonatory aerodynamics in connected speech.

OBJECTIVES/HYPOTHESIS: To establish normative values for phonatory aerodynamic measurements in connected speech across adult ages and gender. STUDY DESIGN: Prospective data collection across group design. METHODS: One hundred fifty adults aged >18 years without voice complaints were stratified into three equal-age groups (group 1 [ages 18-39 years]; group 2 [ages 40-59 years], and group 3 [ages 60 + years]) and two equal-gender groups (male and female) resulting in 25 participants in each category. Participants read the first four sentences of the Rainbow Passage at comfortable pitch and loudness to obtain a connected speech sample. The following dependent variables were analyzed: breath number, reading passage duration, mean phonatory airflow, inspiratory airflow duration, and expiratory airflow duration. RESULTS: A gender effect was found for mean phonatory airflow, with males showing significantly greater phonatory airflow than females during connected speech (P < .001). Number of breaths was significantly greater for group 3 than group 2 (P < .001) and group 1 (P < .001). Duration, and inspiratory and expiratory airflow durations were all significantly greater for group 3 (P < .001) than group 2 (P < .001) than group 1 (P < .001). CONCLUSIONS: This study provides normative data for phonatory aerodynamics in adult connected speech. Significant age and gender effects were observed. Laryngoscope, 128:909-914, 2018.