Gender-specific reference ranges of the vocal extent measure in young and healthy adults.

Objective: The recently developed vocal extent measure (VEM) quantifies a patient's vocal capacity as documented in the voice range profile (VRP). This study presents the first reference ranges of the VEM for young subjects without voice complaints. Furthermore, this study investigates the influence of gender on the VEM as well as the correlation of the VEM with the dysphonia severity index (DSI).Patients and methods: Reference ranges were captured by combining a retrospective analysis of subjects who received a medical fitness certificate of a healthy voice (n = 135) and a prospective analysis of adult volunteers without voice complaints (n = 67). Every participant obtained a standardized voice assessment comprising videolaryngostroboscopy, auditory-perceptual analysis, acoustic analysis, VRP, and the Voice Handicap Index (VHI-9i).Results: A total of 202 subjects were recruited and investigated. Due to our stringent selection criteria, 51 participants had to be excluded from further analysis. The remaining data of 151 participants (52 males, 99 females), aged 18-39 years (mean 24, SD 5), were analysed in more detail. The mean of the VEM amounted to 123.7 (SD 12.6) for males and 114.4 (SD 13.3) for females. The values differed significantly between both sexes and correlated significantly with the corresponding DSI values.Conclusion: By introducing the first reference values, this study represents the next step of implementing the VEM in daily phoniatric diagnostics. These values serve as a basis to interpret the VEM regarding the degree of severity of voice disorders and to evaluate treatment success.

Efficacy of Phonosurgery, Logopedic Voice Treatment and Vocal Pedagogy in Common Voice Problems of Singers.

INTRODUCTION: Functional and organic impairments of the singing voice are common career-threatening problems of singers presenting in phoniatric and laryngological departments. The objective was to evaluate the efficacy of phonosurgery, logopedic voice treatment and vocal pedagogy in common organic and functional voice problems of singers, including investigation of the recently introduced parameter vocal extent measure (VEM). METHODS: In a prospective clinical study, the analysis of treatment outcome in 76 singers [57 female, 19 male; 38 ± 11 years (mean ± SD)] was based on pre- and post-therapeutic voice function diagnostics and videolaryngostroboscopy. Examination instruments included auditory-perceptual voice assessment, voice range profile (VRP), the VEM calculated from area and shape of the VRP, acoustic-aerodynamic analysis, and patients' self-assessment (e.g., Singing Voice Handicap Index). RESULTS: While 28% of all singers (21/76) presented with functional dysphonia, 72% (55/76) were diagnosed with organic vocal fold changes, of which marginal edema (n = 25), nodules (n = 9), and polyps (n = 8) were the most common pathologic changes. Of the 76 singers, 57% (43) received phonosurgery, 43% (33) had conservative pedagogic (14) and logopedic (19) treatment. Three months post-therapeutically, most parameters had significantly improved. The dysphonia severity index (DSI) increased on average from 6.1 ± 2.0 to 7.4 ± 1.8 (p < 0.001), and the VEM from 113 ± 20 to 124 ± 14 (p < 0.001). Both parameters correlated significantly with each other (rs = 0.41). Phonosurgery had the largest impact on the improvement of vocal function. Conservative therapies provided smaller quantitative enhancements but also qualitative vocal restoration with recovered artistic capabilities. CONCLUSIONS: Depending on individual medical indication, phonosurgery, logopedic treatment and voice teaching are all effective, objectively and subjectively satisfactory therapies to improve the impaired singing voice. The use of VEM in singers with functional and organic dysphonia objectifies and quantifies their vocal capacity as documented in the VRP. Complementing the established DSI, VEM introduction into practical objective voice diagnostics is appropriate and desirable especially for the treatment of singers.

The Vocal Extent Measure: Development of a Novel Parameter in Voice Diagnostics and Initial Clinical Experience.

Voice range profile (VRP) and evaluation using the dysphonia severity index (DSI) represent essentials of instrument-based objective voice diagnostics and are implemented in different standardized registration programs. The respective measurement results, however, show differences. The aim of the study was to prove these differences statistically and to develop a new parameter, the Vocal Extent Measure (VEM), which is not influenced by the measurement program. VRPs of 97 subjects were recorded by two examiners using the established registration programs DiVAS (XION medical) and LingWAVES (WEVOSYS) simultaneously. The VEM was developed on the basis of VRP area and perimeter. All 194 VRP files were analyzed for various parameters and gender independence. The registration programs exhibited significant differences in several vocal parameters. A significant gender influence for DSI was found with DiVAS (p < 0.01), but not with LingWAVES. The VEM quantified the dynamic performance and frequency range by a unidimensional, interval-scaled value without unit, mostly between 0 and 120. This novel parameter represents an intelligible and user-friendly positive measure of vocal function, allows simple and stable VRP description, and seems to be suitable for quantification of vocal capacity. In contrast to DSI, the VEM proved to be less susceptible to registration program and gender.