Evolution of vocal fold nodules from childhood to adolescence.

SUMMARY: Bilateral (quasi) symmetrical lesions of the anterior third of the vocal folds, commonly called vocal fold nodules (VFNs) are the most frequent vocal fold lesions in childhood caused by vocal abuse and hyperfunction. This study evaluates their long-term genesis with or without surgery and voice therapy. A group of 91 postmutational adolescents (mean age, 16 years), in whom VFNs were diagnosed in childhood, were questioned to analyze the evolution of their complaints. Thirty four of them could be clinically reexamined by means of the European Laryngological Society-protocol, including a complete laryngological investigation and voice assessment. A total of 21% of the questioned group (n=91) had voice complaints persisting into postpubescence with a statistically significant difference (P

Predicting vocal outcome by means of a vocal endurance test: a 5-year follow-up study in female teachers.

OBJECTIVES: Investigate whether vocal problems in future professional activities can be predicted by early laryngeal and phoniatric evaluation and whether a vocal endurance test can contribute to this evaluation. STUDY DESIGN: Five-year follow-up study of 30 female education majors, initially documented with a standard voice assessment and a vocal endurance test. Measurements before and after vocal endurance testing were compared and related to the vocal outcome 5 years after the initial testing. METHODS: Voice assessment included perceptual evaluation, airflow measurements, Fo and SPL measurements, voice range profile and laryngeal (stroboscopic) examination. The Standard Tolerance Test, as recommended by the Union of European Phoniatricians, was followed. This data set was completed with a questionnaire concerning the subjects' vocal behavior. This questionnaire was repeated 5 years later. RESULTS: No significant differences were found for ENT scores (laryngostroboscopy) (P = .018). Logistic regression was used to determine a relationship between initial observations and the final outcome. CONCLUSIONS: The role of an endurance test as used in this study is negligible for the prediction of vocal outcome. A combination of laryngeal examination, maximum phonation time, and perceptual evaluation, assessed prior to the endurance test, reveals a prediction of the vocal outcome with a specificity of 90% and a sensitivity of 70%.

The dysphonia severity index: an objective measure of vocal quality based on a multiparameter approach.

The vocal quality of a patient is modeled by means of a Dysphonia Severity Index (DSI), which is designed to establish an objective and quantitative correlate of the perceived vocal quality. The DSI is based on the weighted combination of the following selected set of voice measurements: highest frequency (F(0)-High in Hz), lowest intensity (I-Low in dB), maximum phonation time (MPT in s), and jitter (%). The DSI is derived from a multivariate analysis of 387 subjects with the goal of describing, purely based on objective measures, the perceived voice quality. It is constructed as DSI = 0.13 x MPT + 0.0053 x F(0)-High - 0.26 x I-Low - 1.18 x Jitter (%) + 12.4. The DSI for perceptually normal voices equals +5 and for severely dysphonic voices -5. The more negative the patient's index, the worse is his or her vocal quality. As such, the DSI is especially useful to evaluate therapeutic evolution of dysphonic patients. Additionally, there is a high correlation between the DSI and the Voice Handicap Index score.

Test-retest study of the GRBAS scale: influence of experience and professional background on perceptual rating of voice quality.

Perceptual evaluation was performed by means of the GRBAS scale for a series of nine pathological voice samples that were presented twice to a group of 23 judges, consisting of experienced and inexperienced otolaryngologists (ENTs) and speech-language pathologists (S/LPs). The time interval between ratings was 14 days. Test-retest reliability was moderate. The best agreement between the observers was obtained for the G (grade) parameter and the worst for the S (strained) parameter. Considering the medians of the GRBAS ratings, no significant influence was measured for level of experience or professional background. Yet, based on means, the results show that professional background has a greater impact on perceptual rating than experience.

Is the reliability of a visual analog scale higher than an ordinal scale? An experiment with the GRBAS scale for the perceptual evaluation of dysphonia.

Perceptual evaluation of 14 pathological voices was performed by 29 listeners using the GRBAS scale. To evaluate scale effects on the judgments, 2 versions of the scale were presented: the original 4-point scale and a visual analog scale. Each listener used the same voice samples for both versions of the scale with an interval of 2 weeks. Agreement was found to be higher with the original 4-point scale than with the visual analog version for all scale items G, R, B, A and S. Although a visual analog scale seems to enable a finer judgment of voice quality, this study showed that, with increased freedom of judgment, the interrater agreement decreased considerably. Therefore, we recommend the use of the original 4-point version of the GRBAS scale.

Poor voice quality in future elite vocal performers and professional voice users.

The voice quality of 86 occupational voice users, i.e., students of a high school for audiovisual communication, was assessed by means of a multidimensional test battery containing: the GRBAS scale, videolaryngostroboscopy, maximum phonation time, jitter, lowest intensity, highest frequency, dysphonia severity index (DSI), and voice handicap index (VHI). In a questionnaire on daily habits the prevalence of smoking, eating habits, and vocal abuse were recorded. A comparison of the voice characteristics of the future occupational voice users with a control group revealed significant differences. The results of the VHI and the DSI of these students revealed significantly worse scores than the score of a control group characterized by no vocal complaints. Moreover, the questionnaire on daily habits showed that the future elite vocal performers and professional voice users take less precautions for the care of their voices. These findings support the importance of a good balanced vocal coaching.

Relevance of subglottic pressure in normal and dysphonic subjects.

The purpose of this study was to determine the clinical value of subglottic pressure (SGP) in normal and dysphonic subjects. "The airway interrupted method" was used to measure the intra-oral pressure. Voice samples from 60 healthy subjects and 79 dysphonic patients were recorded under normal conditions of pitch and intensity. In normal subjects, age and gender have no significant impact on mean and peak SGP. The peak SGP measurements are significantly higher in dysphonic patients and could be included in the basic clinical set of objective voice parameters. No differences could be shown between pre- and postoperative assessments or between groups of dysphonic patients.

The perceptual evaluation of voice disorders.

The consent about the necessity of perceptual evaluation in the assessment of patients with voice disorders is almost unanimous. This is not the case with regard to the method or scale. This article gives an outline of historical backgrounds and presents a survey of contemporary perceptual rating scales. Reliability and influencing factors are discussed and recommendations are made with respect to clinical use.