Endoscopia bajo sueño inducido en la apnea obstructiva del sueño (DISE). Estudio comparativo entre las clasificaciones NOHLy VOTE / Drug Induced Sleep Endoscopy (DISE). A comparative study between NOHL and VOTE classifications

Introducción y objetivo: Varias clasificaciones han sido propuestas para expresar los resultados de la endoscopia bajo sueño inducido (DISE) en la apnea obstructiva del sueño (AOS), pero ninguna está globalmente aceptada. El objetivo del estudio es analizar las clasificaciones más utilizadas: NOHL y VOTE, para valorar cuál de ellas aporta más ventajas.Método: Se diseñó un estudio de cohortes prospectivo de 100 pacientes a los que se les realizó una DISE por AOS. Tres otorrinolaringólogos evaluaron de forma ciega los videos de las DISE y codificaron los resultados de acuerdo a las escalas NOHL y VOTE, anotando qué hallazgos determinaban la indicación de cirugía.Resultados: Según el investigador principal, en un 64% se indicó cirugía de un solo nivel, de estos, el paladar fue el más predominante, en el 26% se indicó cirugía multinivel y en un 10% se desestimó cirugía. La concordancia global para expresar los resultados de la DISE según las escalas NOHL y VOTE, en cuanto al grado de obstrucción es moderada / regular a nivel de la epiglotis (k = 0,467) y baja en el resto de estructuras (k = 0,097).Discusión: A pesar de que el grado de acuerdo interobservador es similar en ambas escalas, para VOTE es ligeramente superior.Conclusiones: La DISE es una prueba segura, reproducible y fácil de realizar. Recomendamos el uso de la escala VOTE porque ha demostrado tener un grado de acuerdo interobservador superior, es la escala más utilizada en la literatura y la recomendada en los documentos de consenso. (AU)

Introduction and objective: There is no standardized method to express DISE results. Several classifications have been proposed, but none are globally accepted. The objective of this study is to analyze the most used classifications: NOHL and VOTE to assess which of them provides more advantages. Method: A prospective cohort study of 100 patients who underwent DISE was carried out. Three otolaryngologists blindly evaluated the DISE videos and coded the results according to the NOHL and VOTE scales and at what level surgery was indicated. Results: According to the main researcher, in 64% of patients, surgery of only one level was indicated, being the palate the predominant level, followed by a 26% where multilevel surgery was indicated, and in 10% no surgery was indicated. The global agreement to express the DISE results according to the NOHL, VOTE scales regarding the degree of obstruction is moderate / regular at the level of the epiglottis (k = 0.467) and low in the rest of the structures (k = 0.097). Discussion: Although the degree of interobserver agreement is similar in both scales, for VOTE it is slightly higher. Conclusions: DISE is a safe, reproducible and easy to perform test. We recommend the use of the VOTE scale because it has been demonstrated to have a higher degree of interobserver agreement, it is not only the most widely used scale, but also recommended in consensus documents. (AU)

Adaptación fonética y validación del método de valoración perceptual de la voz CAPE- V al español / Validation of the Spanish adaptation of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V)

Objetivo: Con el propósito de promocionar un abordaje estándar para la evaluación y documentación de las calificaciones perceptuales de la calidad vocal se desarrolló el método CAPE-V (Consensus Auditory-Perceptual Evaluation of Voice). Originalmente diseñado en el idioma inglés, no existe una adaptación del mismo para ser usado en hispanohablantes. El propósito del presente trabajo es proponer una adaptación del protocolo al español y examinar la fiabilidad y la validez empírica de dicha versión. Método: Con el fin de adaptar el protocolo al español, se proponen seis frases de acuerdo a los requerimientos fonéticos del CAPE-V. Se llevó a cabo una validación instrumental de forma prospectiva. La validez de la versión en español del CAPE-V se investigó mediante la determinación de la fiabilidad intra- e interobservador y mediante la comparación de las calificaciones obtenidas mediante el CAPE-V con las obtenidas mediante el GRABS. Resultados: Los coeficientes de fiabilidad interobservador fluctuaron entre el 0,93 para la severidad global y el 0,54 para la intensidad, mientras que la fiabilidad intraobservador varió entre el 0,98 para la severidad global y el 0,85 para la intensidad. La comparación entre las calificaciones obtenidas mediante el método GRABS y el CAPE-V obtuvo resultados entre el 0,86 para la severidad global y el 0,61 para la calidad aérea. Conclusiones: El presente estudio apoya el uso de la versión en español del CAPE-V dada su validez y fiabilidad (AU)

Objective: The Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) was developed.to promote a standardised approach to evaluating and documenting auditory perceptual judgments of vocal quality. This tool was originally developed in English language and its Spanish version is still inexistent. The aim of this study was to develop a Spanish adaptation of CAPE-V and to examine the reliability and empirical validity of this Spanish version. Method: To adapt the CAPE-V protocol to the Spanish language, we proposed 6 phrases phonetically designed according to the CAPE-V requirements. Prospective instrument validation was performed. The validity of the Spanish version of the CAPE-V was examined in 4 ways: intra-rater reliability, inter-rater reliability and CAPE-V versus GRABS judgments. Results: Inter-rater reliability coefficients for the CAPE-V ranged from 0.93 for overall severity to 0.54 for intensity; intra-rater reliability ranged from 0.98 for overall severity to 0.85 for intensity. The comparison of judgments between GRABS and CAPE-V ranged from 0.86 for overall severity to 0.61 for breathiness. Conclusions: The present study supports the use of the Spanish version of CAPE-V because of its validity and reliability (AU)

Validation of the Spanish adaptation of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V).

OBJECTIVE: The Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) was developed.to promote a standardised approach to evaluating and documenting auditory perceptual judgments of vocal quality. This tool was originally developed in English language and its Spanish version is still inexistent. The aim of this study was to develop a Spanish adaptation of CAPE-V and to examine the reliability and empirical validity of this Spanish version. METHOD: To adapt the CAPE-V protocol to the Spanish language, we proposed 6 phrases phonetically designed according to the CAPE-V requirements. Prospective instrument validation was performed. The validity of the Spanish version of the CAPE-V was examined in 4 ways: intra-rater reliability, inter-rater reliability and CAPE-V versus GRABS judgments. RESULTS: Inter-rater reliability coefficients for the CAPE-V ranged from 0.93 for overall severity to 0.54 for intensity; intra-rater reliability ranged from 0.98 for overall severity to 0.85 for intensity. The comparison of judgments between GRABS and CAPE-V ranged from 0.86 for overall severity to 0.61 for breathiness. CONCLUSIONS: The present study supports the use of the Spanish version of CAPE-V because of its validity and reliability.

Valoración de la calidad vocal tras el tratamiento del carcinoma faringolaríngeo avanzado en un protocolo de preservación de órgano / Assessment of vocal quality following treatment of advanced pharyngo-laryngeal carcinoma with a protocol of organ preservation

Introducción y objetivos: Los carcinomas avanzados de faringe y laringe y los distintos métodos que se emplean para su tratamiento tienen un impacto directo en la función vocal, la comunicación oral y la deglución, alteraciones que pueden influir en la capacidad laboral y en la calidad de vida general. Pacientes y métodos: Con el fin de conocer la salud vocal de los pacientes tratados mediante un protocolo de preservación de órgano presentamos los resultados vocales de 17 pacientes tras ser tratados mediante una combinación de radioterapia y quimioterapia, y que han sido seguidos un mínimo de 6 meses, encontrándose vivos sin evidencia de enfermedad en el momento del estudio. Se realiza una valoración objetiva de la voz mediante espectrografía, análisis perceptual por el sistema GRABS y el Voice Handicap Index como metodología aconsejada, que puede ser empleada en el futuro en estudios más extensos. Resultados: Se observaron voces normales o levemente disfónicas en 5 pacientes (29,4%), y moderadas/severas en 12 (70,6%). Espectrográficamente, las 17 muestras se clasificaron como normales en 4 casos (23,4%), Grado I en 3 casos (17, 6%), Grado II en 3 (17,6%), Grado III en 4 (23,5%) y Grado IV en 2 (11,7%). Las puntuaciones en el cuestionario Voice Handicap Index se encontraron dentro de los rangos normales en todos los casos, excepto en 4 (23,5%). Conclusiones: El análisis acústico de la voz de los pacientes de esta serie demuestra que el daño que se produce tras un tratamiento de preservación de órgano causa un amplio rango de resultados vocales. No obstante, la sensación de incapacidad de estos pacientes es mínima. En este estudio se propone el uso de instrumentos homogéneos (espectrografía, GRABS, Tiempo Máximo de Fonación y Voice Handicap Index) para ser usados en futuros metaanálisis (AU)

Introduction and objectives: Advanced laryngeal and pharyngeal cancer, as well as methods to treat them, have a direct impact on voice function, speech communication and deglutition. Such alterations in function can influence employability and general quality of life. Patients and methods: To characterise the vocal status of the patients treated with an organ-preservation protocol, we report the voice outcomes of 17 patients who were alive and disease free at the time of the survey, with a minimum follow-up of 6 months, after a combination of radiotherapy and chemotherapy to treat advanced cancer. Objective voice assessment by means of spectrographic analysis, the GRBAS perceptual analysis system and the Voice Handicap Index was the methodology followed, which we suggest could be used in future large-scale investigations. Results: Normal or slightly dysphonic voices were observed in 5 patients (29.4%) and moderate/severe in 12 (70.6%). Spectrographically, the 17 samples were classified as normal in 4 cases (23.4%), Grade I in 3 cases (17.6%), Grade II in 3 (17.6%), Grade III in 4 (23.5%) and Grade IV in 2 (11.7%). The Voice Handicap Index questionnaire, which was completed by the patients themselves, gave normal results in all the patients except for 4 (23.5%). Conclusions: The voice acoustic analysis of this series shows that the damage related to the organ-preservation protocol displays a relatively wide range of voice function outcomes. To characterise the vocal status of these patients reliably, we propose using homogeneous instruments (spectrography, GRBAS scale, Maximum Phonation Time and Voice Handicap Index) in future meta-analyses (AU)

Análisis acústico de la voz mediante el programa Praat: estudio comparativo con el programa Dr. Speech / Acoustic voice analysis using the Praat program: Comparative study with the Dr. Speech program

Introducción y objetivos: El protocolo de la European Laringological Society (ELS) para la valoración funcional de la disfonía incluye 5 dimensiones: percepción, análisis acústico, videoestroboscopia, aerodinámica y autovaloración del paciente. El objetivo de este trabajo es correlacionar los resultados obtenidos con el programa comercial Dr. Speech con los obtenidos con el programa gratuito Praat en 2 ámbitos: 1. Espectrograma de banda estrecha (presencia de ruido según Yanagihara y presencia de subarmónicos) (semicuantitativo). 2. Parámetros acústicos de la voz (jitter, shimmer, relación armónico-ruido, frecuencia fundamental) (cuantitativo). Material y métodos: Se estudiaron un total de 99 muestras de voz diagnosticadas mediante videoestroboscopia de edema de Reinke. En este estudio un observador independiente utilizó el Dr. Speech 3.0 y otro el Praat (Phonetic Sciences, University of Amsterdam). El análisis espectrográfico consistió en obtener un espectrograma de banda estrecha a partir de las anteriores voces digitalizadas por parte de los 2 observadores independientes. Después determinaron la presencia de ruido en el espectrograma siguiendo los grados de Yanagihara y la presencia de subarmónicos. Por último, se obtuvieron los siguientes parámetros acústicos: jitter, shimmer, relación armónico-ruido (HNR) y el valor de la frecuencia fundamental (Fo). Resultados: Los resultados indican que el espectrograma y el parámetro de perturbación de la frecuencia jitter son comparables en los 2 programas. También es comparable el parámetro de perturbación de la amplitud shimmer, a pesar de haber analizado tanto voces de tipo 1, como de tipo 2 y de tipo 3. Conclusiones: Los programas Praat y Dr. Speech ofrecen similares resultados en el análisis acústico de las voces patológicas (AU)

Introduction and objectives: The European Laryngological Society (ELS) basic protocol for functional assessment of voice pathology includes 5 different approaches: perception, videostroboscopy, acoustics, aerodynamics and subjective rating by the patient. In this study we focused on acoustic voice analysis. The purpose of the present study was to correlate the results obtained by the commercial software Dr. Speech and the free software Praat in 2 fields: 1. Narrow-band spectrogram (the presence of noise according to Yanagihara, and the presence of subharmonics) (semi-quantitative). 2. Voice acoustic parameters (jitter, shimmer, harmonics-to-noise ratio, fundamental frequency) (quantitative). Material and methods: We studied a total of 99 voice samples from individuals with Reinke's oedema diagnosed using videostroboscopy. One independent observer used Dr. Speech 3.0 and a second one used the Praat program (Phonetic Sciences, University of Amsterdam). The spectrographic analysis consisted of obtaining a narrow-band spectrogram from the previous digitalised voice samples by the 2 independent observers. They then determined the presence of noise in the spectrogram, using the Yanagihara grades, as well as the presence of subharmonics. As a final result, the acoustic parameters of jitter, shimmer, harmonics-to-noise ratio and fundamental frequency were obtained from the 2 acoustic analysis programs. Results: The results indicated that the sound spectrogram and the numerical values obtained for shimmer and jitter were similar for both computer programs, even though types 1, 2 and 3 voice samples were analysed. Conclusions: The Praat and Dr. Speech programs provide similar results in the acoustic analysis of pathological voices (AU)

[Acoustic voice analysis using the Praat program: comparative study with the Dr. Speech program]. / Análisis acústico de la voz mediante el progama Praat: estudio comparativo con el programa Dr. Speech.

INTRODUCTION AND OBJECTIVES: The European Laryngological Society (ELS) basic protocol for functional assessment of voice pathology includes 5 different approaches: perception, videostroboscopy, acoustics, aerodynamics and subjective rating by the patient. In this study we focused on acoustic voice analysis. The purpose of the present study was to correlate the results obtained by the commercial software Dr. Speech and the free software Praat in 2 fields: 1. Narrow-band spectrogram (the presence of noise according to Yanagihara, and the presence of subharmonics) (semi-quantitative). 2. Voice acoustic parameters (jitter, shimmer, harmonics-to-noise ratio, fundamental frequency) (quantitative). MATERIAL AND METHODS: We studied a total of 99 voice samples from individuals with Reinke's oedema diagnosed using videostroboscopy. One independent observer used Dr. Speech 3.0 and a second one used the Praat program (Phonetic Sciences, University of Amsterdam). The spectrographic analysis consisted of obtaining a narrow-band spectrogram from the previous digitalised voice samples by the 2 independent observers. They then determined the presence of noise in the spectrogram, using the Yanagihara grades, as well as the presence of subharmonics. As a final result, the acoustic parameters of jitter, shimmer, harmonics-to-noise ratio and fundamental frequency were obtained from the 2 acoustic analysis programs. RESULTS: The results indicated that the sound spectrogram and the numerical values obtained for shimmer and jitter were similar for both computer programs, even though types 1, 2 and 3 voice samples were analysed. CONCLUSIONS: The Praat and Dr. Speech programs provide similar results in the acoustic analysis of pathological voices.

Assessment of vocal quality following treatment of advanced pharyngo-laryngeal carcinoma with a protocol of organ preservation.

INTRODUCTION AND OBJECTIVES: Advanced laryngeal and pharyngeal cancer, as well as methods to treat them, have a direct impact on voice function, speech communication and deglutition. Such alterations in function can influence employability and general quality of life. PATIENTS AND METHODS: To characterise the vocal status of the patients treated with an organ-preservation protocol, we report the voice outcomes of 17 patients who were alive and disease free at the time of the survey, with a minimum follow-up of 6 months, after a combination of radiotherapy and chemotherapy to treat advanced cancer. Objective voice assessment by means of spectrographic analysis, the GRBAS perceptual analysis system and the Voice Handicap Index was the methodology followed, which we suggest could be used in future large-scale investigations. RESULTS: Normal or slightly dysphonic voices were observed in 5 patients (29.4%) and moderate/severe in 12 (70.6%). Spectrographically, the 17 samples were classified as normal in 4 cases (23.4%), Grade I in 3 cases (17.6%), Grade II in 3 (17.6%), Grade III in 4 (23.5%) and Grade IV in 2 (11.7%). The Voice Handicap Index questionnaire, which was completed by the patients themselves, gave normal results in all the patients except for 4 (23.5%). CONCLUSIONS: The voice acoustic analysis of this series shows that the damage related to the organ-preservation protocol displays a relatively wide range of voice function outcomes. To characterise the vocal status of these patients reliably, we propose using homogeneous instruments (spectrography, GRBAS scale, Maximum Phonation Time and Voice Handicap Index) in future meta-analyses.