Spectrographic Voice Analysis Protocol (SAP): Convergent, Concurrent, and Accuracy Validity.

OBJECTIVE: To verify the convergent and concurrent validity of the Spectrographic Voice Analysis Protocol (SAP) and its accuracy to discriminate dysphonic from nondysphonic patients. METHOD: The study used 82 vowel /Ɛ/ samples and their respective narrowband spectrograms, analyzed with SAP. Cepstral peak prominence (CPP) and cepstral peak prominence smoothed (CPPS) verified the convergent validity of the SAP total score, while the general grade of vocal deviation (GG) verified the concurrent validity of the SAP total score. The ROC (receive operator curve) curve and its accuracy, sensitivity, and specificity values, positive predictive value (PPV) and negative predictive value (NPV), and positive likelihood ratio (LR+) and negative likelihood ratio (LR-) verified the accuracy of the SAP score to discriminate dysphonic from nondysphonic individuals. RESULTS: Dysphonic and nondysphonic had different SAP total scores. In the convergent validity, the SAP score had a weak and moderate negative correlation, respectively, with CPP and CPPS, as well as a moderate positive correlation with GG. SAP performed well in discriminating dysphonic from nondysphonic individuals (area under the curve = 82.0%; sensitivity = 91.7%; specificity = 51.7%; PPV = 93.7%; NPV = 44.0%; LR+ = 6.21; LR- = 0.53) based on the 8-point cutoff score. CONCLUSION: SAP has convergent validity with CPP and CPPS and concurrent validity with GG. The SAP total score performed well in discriminating dysphonic from nondysphonic individuals. However, the specificity, NPV, and LR- values justify cautiously using SAP, always in combination with other information in clinical voice assessment.

Cough Severity Index: Validation in Brazilian Portuguese.

OBJECTIVE: To develop a validity profile for the cough severity index in the Brazilian Portuguese language (CSI-Br). METHODS: The study sample consisted of 100 participants divided into Chronic Cough Group (CG; 50 individuals with a mean age of 46.4; standard deviation [SD]: 11.7) and Healthy Control Group (HCG; 50 individuals with a mean age of 33.0 [SD: 12.3]). The data collection procedures were as follows: (a) application of CSI-Br for all participants; (b) application of the Voice Handicap Index (VHI)-10 and the Newcastle Laryngeal Hypersensitivity Questionnaire (LHQ-Br) in the CG; (c) application of CSI-Br for test-retest reliability with an interim of between 2-14 days. The CSI-Br validation was composed of five stages: construct validity, reliability, reproducibility, convergent validity, and discriminant validity. RESULTS: In construct validity, the instrument identified two factors and explained 67.6% of the total variance. The reliability had a value of a=0.914. Reproducibility showed an ICC value of 0.909. CSI-Br showed a negative correlation with VHI-10 and a positive correlation with LHQ-Br in convergent validity. In discriminant validity, all items and factors differentiated participants in the CG from those in the HCG. CONCLUSION: The ten-item CSI-Br with two factors is reliable and valid for analyzing the severity of chronic cough symptoms in Brazilian individuals.

Validation of Newcastle Laryngeal Hypersensitivity Questionnaire (LHQ-Br) in Brazilian Portuguese.

OBJECTIVE: To analyze the validity of the Newcastle Laryngeal Hypersensitivity Questionnaire (LHQ-Br) in Brazilian Portuguese. METHODS: The present study sample consisted of 89 individuals from the laryngeal hypersensitivity group and 41 individuals from the healthy group. The Newcastle Laryngeal Hypersensitivity Questionnaire's validation process for Brazilian Portuguese was composed of five stages: construct validity, reliability of internal consistency, and reliability regarding reproducibility, convergent validity, and discriminant validity. The software SPSS 25.0 was used. A significance level of 5% was considered statistically significant. RESULTS: In construct validation, it was observed that the instrument was unifactorial; however, it was necessary to exclude two items with a low commonality that did not fit the model. The final instrument consisted of 12 items, and a factor called total, which explained 70.55% of the variance. In the internal consistency analysis, Cronbach's alpha was 0.962. The reproducibility had an intraclass correlation coefficient (ICC) was 0.949. In terms of convergent validity, there was a negative correlation between the total domain of the LHQ-Br and the total Cough Severity Index translated and adapted for the Brazilian Portuguese (P = 0.001) and total Voice Handicap Index - 10 (P < 0.001). Discriminant validity showed that ten items and the total factor differentiated healthy group individuals from those in the laryngeal hypersensitivity group. CONCLUSION: The 12-item LHQ-Br is valid and reliable for measuring the self-perception of laryngeal sensation associated with Brazilian patients with laryngeal hypersensitivity syndrome.

Effectiveness of the Therapy Program for Management of Chronic Cough: Preliminary Data From a Randomized Clinical Trial.

PURPOSE: The purpose of this study is to analyze the effectiveness of the Therapy Program for Management of Chronic Cough (TMCC) in laryngeal sensations and symptoms related to the cough in individuals with chronic refractory cough (CRC). METHOD: This research is a randomized double-blind clinical trial (Register Number: RBR-4m6x29). Eleven participants were allocated to two groups by parallel randomization: The Experimental Group-consisting of six individuals who underwent the TMCC; and the Control Group-consisting of five individuals who underwent the Comprehensive Vocal Rehabilitation Program (CVRP). Two primary outcomes were analyzed: self-perception of laryngeal sensations (Newcastle Laryngeal Hypersensitivity Questionnaire [LHQ-Br]) and self-perception of symptoms of upper airway-related cough (Cough Severity Index [CSI-Br]). The two-way repeated-measures analysis of variance was used to compare the evaluation moments and intervention groups. For multiple comparisons, the Tukey test with Bonferroni correction was used. To evaluate the effect size, eta partial square was used. RESULTS: There was no difference between groups for any outcomes analyzed. There was a statistically significant difference with a large effect size for the moment factor in all outcomes. A statistically significant difference was observed with a large effect size for the interaction effect between group and moment for LHQ-Br total and CSI-Br psychological and functional. CONCLUSIONS: The TMCC and CVRP were effective for the rehabilitation of CRC, considering the viewpoint of the subject. The TMCC improved laryngeal sensations and psychological and functional symptoms, while CVRP was relevant to improve psychological and functional symptoms in individuals with CRC.

Cough Severity Index in Brazilian Portuguese: Translation and Cross-Cultural Adaptation.

OBJECTIVE: To translate and cross-culturally adapt the Cough Severity Index to Brazilian Portuguese. MATERIAL AND METHODS: This is a study with observational, cross-sectional, and analytical design. The procedure for translation and cross-cultural adaptation followed the recommendations of the Scientific Advisory Committee of the Medical Outcomes Trust and was performed in five stages: translation, synthesis, back translation, committee review, and pretesting. The sample for the pretest consisted of 34 participants with refractory chronic cough, 11 males and 23 females, with an average age of 48 years and 1 month. RESULTS: The title of the questionnaire, the answer options, and seven of the ten questions were agreed upon by three judges, the remaining three questions were retranslated by a fourth judge. After back-translation and committee review, editing of question five was necessary. The option "never" was more frequently selected for four questions and the option "always" for six questions. There was a significantly higher proportion of other response categories of the instrument compared to the response category "not applicable." CONCLUSION: This study resulted in the elaboration of a translated and cross-culturally adapted version of the Cough Severity Index in Brazilian Portuguese.

Voice Handicap Index-Throat: Translation and Cross-Cultural Adaptation to Brazilian Portuguese.

OBJECTIVE: This study aims to translate and cross-culturally adapt the throat scale of the Voice Handicap Index to the Brazilian Portuguese language.uracy. MATERIAL AND METHODS: This was performed in five phases translation, synthesis, back translation, review, and pretest. Fifty subjects participated in the pretest, of which 22 participants had chronic cough, 13 had laryngopharyngeal reflux, and 15 had behavioral dysphonia. Of the 50 participants, 40 were female and 10 male, with an average age of 44 years and six months. RESULTS: In the translation process, only question four had to be translated by a fourth judge. After the back-translation and committee review steps, it was necessary to make adjustments to questions one, four, five, seven, eight, nine, and 10. With regard to question five, the "never" option was significantly associated with the clinical group with behavioral dysphonia (P = 0.016), and with regard to question eight, the option was occasionally significantly associated with the clinical group with laryngopharyngeal reflux (P = 0.015). For question six, all the response categories of the questionnaire, had a significantly higher proportion compared to "not applicable" (P < 0.001). For the other questions, no participants selected the "not applicable" option. CONCLUSION: The translation and cross-cultural adaptation of the throat scale of the Voice Handicap Index to Brazilian Portuguese was performed successfully; the Voice Handicap Index in Brazilian Portuguese prepared herein was called the Índice de Desvantagem Vocal-Garganta.

Evidence of Internal Consistency in the Spectrographic Analysis Protocol.

OBJECTIVE: To verify the validity in the internal consistency in the spectrographic analysis protocol (SAP). MATERIAL AND METHODS: Thirty-nine students of the Speech-Language Pathology graduate program and 38 speech-language pathologists, specialized in voice, participated in the study. The participants made visual inspections of 10 spectrograms and marked the items of the SAP. For analysis of the internal consistency in the SAP, the exploratory factor analysis (EFA) and confirmatory factor analysis were performed. RESULTS: Most items showed corrected item-total correlation above 0.3, indicating that the items have a good relationship with each other and with the SAP as a whole. Six items presented values below the average, suggesting the exclusion of these from the construct. However, three of these were maintained because they were judged as important parameters in clinical practice, requiring the training of judges when using the SAP to properly understand the items. The EFA regrouped the previous domains of the SAP into three factors. All items presented a factor load above 0.4, suggesting the retention of all, except for the items previously indicated, for exclusion. The confirmatory factor analysis corroborated with the EFA and its indexes. CONCLUSION: The SAP has good internal consistency. All items have a good degree of relationship with each other and contribute positively to the protocol as a whole. The final version of the SAP, at this stage, has 15 items (from the 25 items of the initial SAP version), distributed among three domains.