Investigation of Interdisciplinary Differences in Perceptual Evaluation of Voice Disorders.

Ear, nose, and throat (ENT) physicians, speech and language pathologists (SLPs), and singing instructors play complementary roles in the assessment and remediation of voice disorders in performing artists. Given that there are differences among these groups in the training they receive, and that there may be further differences due to their occupational settings and goals, it is unknown whether and to what extent these different disciplines diverge in their perceptions and evaluations of voice quality. Against this background, the present study compared perceptual evaluation of pathological voice by these voice-related disciplines. Using the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) scale, five ENT physicians, five SLPs, and five singing instructors evaluated voice samples recorded from 10 people with pathological voice. The participant groups' scores for each CAPE-V parameter were compared. It was found that the ENT physicians and SLPs were similar in their evaluations, whereas the singing instructors gave higher scores than the ENT physicians and SLPs on several CAPE-V parameters, suggesting that the singing instructors tended to rate the patients' voice quality as more severe on average than ENT physicians and SLPs. These findings highlight the similarities between ENT physicians and SLPs in their perceptual evaluations of pathological voice and suggest that singing instructors may show a more sensitive and heightened perceptual response to pathological voice than the other professional groups, possibly due to differences in occupational experiences and expectations among these voice-related disciplines.

Smoking has detrimental effects on voice related Quality of Life of University Teachers.

Objective: To compare voice related quality of life of smoker and non-smoker university teachers. Method: This Cross-Sectional descriptive study was conducted at Riphah International University over a period of six months January to June, 2022. A sample of N=352 University teachers of both genders, aged 25 to 65 years, who were faculty members and working at least 8 hours per day in teaching positions with at least one-year experience were included in the study. Demographic sheet, Voice Related Quality of Life (VRQOL) and Voice Handicap Index (VHI) were used for data collection and analysis conducted on SPSS Version 21. Mean scores of VRQOL and VHI for smokers and non-smokers were compared using Mann Whitney U Test. & Spearman's correlation was utilized to determine any association between the tool scores. P<0.01 was considered significant. Results: Results reveal that the mean score of Voice related quality of life scale was significantly (p=0.000) higher in smokers compared to non-smokers indicating worse voice quality in smokers. Similarly, voice handicap index scores were much higher in smokers (p=0.000) indicating more handicap in the smokers. Conclusion: The study concludes that smoking has a detrimental effect on voice and voice related quality of life of university teachers and voice related quality of life as determined by VRQOL scale is significantly better in non-smokers.

Temperament and Voice Quality in Patients With Vocal Fold Nodules.

BACKGROUND: Vocal fold nodules are most common in women and patients with vocal fold nodules represent the largest group in voice clinics. The prevalence of vocal fold nodules is particularly high in professions where the voice is used on a regular basis. The quality of the voice is influenced by a number of factors, including temperament, stress, and emotional state. These factors can influence the physiological conditions of phonation. The objective of this study was to assess the acoustic parameters of voice in patients with vocal nodules in comparison to healthy controls, and to determine whether voice quality is influenced by emotional state and coping with stress. METHODS: A total of 32 patients admitted to the ENT Department of the University Medical School with voice disorders between March and June 2007 constituted the study group. All patients were found to have a vocal nodule on physical and stroboscopic examination. The control group consisted of 30 healthy individuals who did not report any voice disorders. All subjects underwent voice recordings in the voice laboratory. Following the completion of the voice evaluation form, an aerodynamic assessment (a, s, and s/z-time), an index of vocal impairment, the Rosenbaum's Learned Resourcefulness Scale, and the Temperament and Characteristics Inventory (Temperament Evaluation of Memphis, Pisa, Paris, San Diego Autoquestionaire), all subjects underwent further assessment. Acoustic analysis was conducted using the CSL program in Multidimensional voice program analysis and the Vocal Assessment component of Dr. Speech. RESULTS: The decrease in maximum phonation time in the study group was statistically significant. There were statistically significant differences in the parameters Mean Fundamental Frequence, Jitter, Relative Avarage Perturbation, Pitch Perturbation Quotient, Shimmer in dB, Shimmer, Amplitude Perturbation Quotient, Noise Hormonic Ratio, Soft Phonation Index from the Multidimensional voice program analysis, Jitter, Shimmer% from the voice assessment, and the perceptual rating (H, R, and B) from Dr. Speech's voice assessment analysis. The differences in the dimensions of anxious temperament and the examination of stress problem-solving strategies were significant between the study group and the control subjects. Differences in aerodynamic and acoustic parameters were found between disordered and healthy groups, as well as between individuals with different personalities. Overall, those with nodules were less likely to manage stress well than those without nodules. CONCLUSIONS: The study group and the control subjects showed significant differences in anxious temperament dimensions and stress problem-solving strategies. There were also differences in aerodynamic and acoustic parameters between the disordered and healthy groups, as well as between the groups with and without personality temperament differences. Overall, those with nodules were less likely to manage stress well than those without nodules. This finding indicates that stress management options are not effectively utilized in patients with vocal fold nodules. So, it might be a good idea to look into some kind of therapeutic approach and patient education for stress management.

Voice quality after surgery or radiotherapy for glottic T1 squamous cell carcinoma: Results of the VOQUAL study.

PURPOSE: Many series have compared voice quality after radiotherapy or surgery for cT1 glottic carcinoma. Different meta-analyses identify better results for radiotherapy while others do not identify any difference, some finally find a superiority of surgery. The purpose of this study was to compare the voice quality in the long term of patients who underwent transoral surgery versus exclusive irradiation for the treatment of cT1 glottic carcinoma. MATERIAL AND METHODS: The VOQUAL study was a pilot comparative multicenter cross-sectional study. The primary endpoint was the Voice Handicap Index comparison between two groups (radiotherapy or surgery). The voice assessment also consisted in the heteroevaluation of voice quality by the Grade, Roughness, Breathness, Asthenia, and Strain rating scale reported by Hirano. RESULTS: The study included 41 adult patients with cT1 carcinoma of the vocal cord treated by cordectomy or exclusive radiation in two oncologic centers. The median Voice Handicap Index value was 20 [8; 32.5] in the surgery group and 10 [4; 18.5] in the radiotherapy group. There was no statistically significant difference between the median values and the various components F, P and E of the questionnaire (P=0.1585). The median value of the numeric dysphonia Grade, Roughness, Breathness, Asthenia, and Strain scale was 2 [0; 5] in the surgery group and 2 [0.25; 3.75] in the radiotherapy group. There was no statistically significant difference between these values (P=0.78). CONCLUSION: Our study did not show any significant difference on the primary endpoints of Voice Handicap Index and Grade, Roughness, Breathness, Asthenia, and Strain scores. LEVEL OF EVIDENCE: III. CLINICAL TRIAL REGISTRATION: The VOQUAL study was registered on the ClinicalTrials.gov platform under the number NCT04447456, in July 2020.

Effectiveness of Voice Therapy on Voice Quality and Function in Individuals with Unilateral Vocal Fold Paralysis: Systematic Review and Meta-Analysis.

BACKGROUND: Unilateral vocal fold paralysis (UVFP), characterized by immobility of one vocal fold, results from injuries of recurrent laryngeal nerves. Voice therapy is a conservative intervention aiming to address these symptoms, but standard protocols are lacking. In this study, we provided an updated review of voice therapy for UVFP over the past 3 years and analyzed the effect of voice therapy from the perspective of voice assessment recommended by the guidelines of the European Laryngological Society and the Union of the European Phoniatricians in 2023. METHODS: Following preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 statement, we searched the databases, including PubMed, Embase, Web of Science, the Cochrane Library, and SCOPUS, from their earliest records to December 1, 2023. Quality assessment utilized Cochrane Risk of Bias and Risk Of Bias In Non-randomized Studies of Interventions tools. Data extraction encompassed study design, participant characteristics, therapy protocols, and outcome measures, including subjective and objective assessments. We performed heterogeneity analysis by calculating the I2 statistic and meta-analysis by calculating the standardized difference of means and weighted mean differences. RESULTS: Our systematic review and meta-analysis included 12 studies encompassing 459 patients. The review revealed a predominance of female participants across studies. Therapy protocols primarily included breathing control, laryngeal manipulation, and resonance training, often supplemented by home exercises. Outcome measures demonstrated significant improvements in subjective parameter: Voice Handicap Index ((standard mean difference) SMD = -1.51, P < 0.001), acoustic parameters: fundamental frequency (SMD = -0.38, P = 0.003), jitter (SMD = -0.97, P < 0.001), shimmer (SMD = -0.94, P < 0.001), and noise-to-harmonic ratio (SMD = -0.89, P < 0.001), and aerodynamic parameters: maximum phonation time (SMD = 1.29, P < 0.001), with early intervention yielding enhanced rate of complete glottal closure. DISCUSSION: Two randomized controlled trials (RCTs) involved patients aware of their allocation to the treatment group, and the remaining 10 studies were retrospective, leading to bias from deviations in the intended intervention. Subjective and aerodynamic parameter inconsistency was observed, but after excluding studies with the onset of UVFP greater than 12 months, the heterogeneity of VHI scores decreased. The funnel plot was grossly symmetrical in the publication bias test. Significant improvements were noted in subjective, acoustic, and aerodynamic outcomes after intervention. Besides, there were commonalities in protocols, such as breathing control, laryngeal manipulation, and resonance training, often supplemented by home exercises. SYSTEMATIC REVIEW REGISTRATION: This protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on March 28, 2024, registration number: CRD42024529750.

Reliability and Validity of the Turkish Version of the Screening Index for Voice Disorder (SIVD-TR).

OBJECTIVES: We investigated the reliability and validity of the Turkish version of the Screening Index for Voice Disorder (SIVD-TR). METHODS: The original SIVD1 translated into Turkish, followed by a translation back into English by a linguist. The text was finalized by an evaluation committee. This translated version was then administered to a cohort of 223 teachers in Ankara, Turkey, encompassing both those with and without voice disorders (WVD and WOVD). After a duration of 7-14days, a random selection of 53 teachers underwent the questionnaire once more. Statistical analyses were conducted to evaluate the reliability and validity of the index. Cronbach's alpha and test-retest methods were used to scale the reliability. A cutoff point was determined to decide the risk of a voice disorder, by using a Receiver Operating Characteristic curve. The validation process is concluded by computing sensitivity and specificity values, comparing mean scores between WVD and WOVD subjects, and finally examining correlations between SIVD-TR and the Turkish version of the Voice Handicap Index (VHI-10). RESULTS: The internal consistency reliability exhibited high significance, with Cronbach's alpha measuring at 0.872. The test-retest correlation coefficient for the total scores was 0.80. The SIVD-TR consists of 12 symptoms, each accounting for 1 point on the scale. The identified cutoff for identifying the risk of a voice disorder is 4 (four) symptoms, with a sensitivity of 55.2%. A correlation of 69% was observed between SIVD-TR and VHI-TR. A significant association was noted between the risk of having a voice disorder and the actual presence of a voice disorder. Subjects with a voice disorder exhibited higher mean SIVD scores, providing further evidence of the questionnaire's discriminative validity. CONCLUSION: The Turkish adaptation of SIVD demonstrated both reliability and validity, establishing itself as a robust tool for identifying voice disorders.

Assessment of Voice Quality and Vocal Cord Paralysis After Endarterectomy.

Introduction: Recurrent laryngeal nerve palsy is a rare but important complication after endarterectomy (CEA). The impact on voice quality after this procedure is also important. The aim of the study was to assess voice quality and vocal cord function after CEA. Material and Methods: 200 patients were enrolled in the study. Inclusion criteria were indications for CEA and patient consent to the procedure. Endoscopic examination of the larynx was performed before the procedure, immediately after the procedure, on the 2nd day after the procedure, then 3 month and 6 months after the procedure. Voice was assessed by maximum phonation time (MPT), GRBAS scale, Voice Handicap Index (VHI) and the Voice-Related Quality of Life (V-RQOL) questionnaire. Results: In the study group, the results on the GRBAS scale were significantly worse and the average MPT was shorter compared to the control group. In the V-RQOL assessment, patients rated their voice as fair or good, significantly more often noticed that they had difficulty speaking loudly and being heard, and that they felt short of air when speaking. In VHI-30, the total score was significantly higher in the study group compared to the control group. Voice disorders after the procedure were reported by 68 patients, while a disorder of the recurrent laryngeal nerve was observed immediately after the procedure in 32 patients. Most vocal cord disorders were transient. Ultimately, 3% of patients were diagnosed with vocal cord paralysis. Conclusion: Cranial nerves paralysis, including the recurrent laryngeal nerve, are a common complication after CEA. Majority the paralysis is transient, but requires appropriate diagnostic and therapeutic procedures. Vocal cord evaluation is a non-invasive and widely available examination and should be performed pre- and postoperatively after all neck surgeries. The incidence of voice disorders after CEA significantly affects the quality of life of patients and requires voice rehabilitation and patient care with psychological support.

Diagnostic Accuracy of DSI and AVQI v.02.03 in Discriminating across the Perceptual Levels of Dysphonia in Kannada Speaking Population.

The present study investigated and compared the diagnostic accuracy of Dysphonia Severity Index (DSI) and Acoustic Voice Quality Index (AVQI) in Indian adults in the age range of 18-40years across different levels of dysphonia severity. Normophonic individuals (n=163) and individuals with dysphonia (n=134) were selected using purposive sampling in the age range of 18-40years. For DSI, Computerized Speech Lab 4500 and for AVQI, Praat 6.1.03 was used for recording. The results of receiver operating characteristics (ROC) analysis for DSI have revealed that DSI can discriminate the normophonic versus mild, mild versus moderate, and moderate versus severe dysphonic with cut-off values of 1.36, -1.83, and -4.07, respectively. The sensitivity and specificity reported for mild versus moderate and moderate versus severe are slightly lower for obtained threshold points. For AVQI v.02.03, ROC analysis revealed that high sensitivity and specificity cut-off points for normophonic versus mild, mild versus moderate, and moderate versus severe dysphonic are 2.50, 3.86, and 6.21, respectively. AVQI is a more effective technique than DSI for distinguishing between dysphonia severities levels, particularly when it comes to mild versus moderate and moderate versus severe, according to comparisons of AROC curves made using the DeLang method.

Speech and neuroimaging effects following HiCommunication: a randomized controlled group intervention trial in Parkinson's disease.

Speech, voice and communication changes are common in Parkinson's disease. HiCommunication is a novel group intervention for speech and communication in Parkinson's disease based on principles driving neuroplasticity. In a randomized controlled trial, 95 participants with Parkinson's disease were allocated to HiCommunication or an active control intervention. Acoustic analysis was performed pre-, post- and six months after intervention. Intention-to-treat analyses with missing values imputed in linear multilevel models and complimentary per-protocol analyses were performed. The proportion of participants with a clinically relevant increase in the primary outcome measure of voice sound level was calculated. Resting-state functional MRI was performed pre- and post-intervention. Spectral dynamic causal modelling and the parametric empirical Bayes methods were applied to resting-state functional MRI data to describe effective connectivity changes in a speech-motor-related network of brain regions. From pre- to post-intervention, there were significant group-by-time interaction effects for the measures voice sound level in text reading (unstandardized b = 2.3, P = 0.003), voice sound level in monologue (unstandardized b = 2.1, P = 0.009), Acoustic Voice Quality Index (unstandardized b = -0.5, P = 0.016) and Harmonics-to-Noise Ratio (unstandardized b = 1.3, P = 0.014) post-intervention. For 59% of the participants, the increase in voice sound level after HiCommunication was clinically relevant. There were no sustained effects at the six-month follow-up. In the effective connectivity analysis, there was a significant decrease in inhibitory self-connectivity in the left supplementary motor area and increased connectivity from the right supplementary motor area to the left paracentral gyrus after HiCommunication compared to after the active control intervention. In conclusion, the HiCommunication intervention showed promising effects on voice sound level and voice quality in people with Parkinson's disease, motivating investigations of barriers and facilitators for implementation of the intervention in healthcare settings. Resting-state brain effective connectivity was altered following the intervention in areas implicated, possibly due to reorganization in brain networks.

Cepstral Analysis of Voice in Patients With Temporomandibular Disorders.

OBJECTIVES: This study aimed to assess the voice quality of patients with temporomandibular disorders (TMDs) compared with healthy subjects using cepstral analysis and investigate the relationship between the TMD severity and the values of cepstral analysis. METHODS: Subjects who met the inclusion criteria completed a general health questionnaire and the Fonseca Anamnestic Index. Patients who had TMDs with FAI were subjected to an examination based on the Diagnostic Criteria for Temporomandibular Disorders. The final sample included 65 subjects, 31 TMDs patients (with a mean age ± standard deviation of 36.64 ± 13.67 years), and 34 healthy individuals in the control group (with a mean age ± standard deviation of 30.35 ± 7.78 years). Cepstral Peak Prominence (CPP) and Smoothened Cepstral Peak Prominence (CPPS) of a sustained vowel and connected speech were computed using Praat software. RESULTS: TMD patients indicated lower cepstral values and lower voice quality compared to the control group. Significant differences were found between TMD and control groups for all cepstral parameters (P < .001) and cepstral measurements showed a moderate to strong negative correlation with TMD severity (P < .001, rho = -0.57 to -0.88). CONCLUSION: The outcomes of the present study indicate that cepstral analysis can accurately distinguish the reduced voice quality of TMD patients from normal voice.

Voice quality after open partial horizontal laryngectomy vs. total laryngectomy with voice prosthesis: a comparative study.

OBJECTIVES: The aim of this study is to compare voice outcomes in open partial horizontal laryngectomy vs. total laryngectomy (TL) with voice prosthesis. METHODS: In this retrospective monocentric study patients undergoing OPHL or TL with voice prosthesis were enrolled during the usual oncological follow-up consultations at the Otolaryngology and Audiology Unit of a University Hospital in the period between July 2022 and June 2023. Acoustic analysis (F0, HNR, NHR), maximum phonation time, I-SECEL and INFV0 scale were used to assess voice outcome. RESULTS: Forty-three patients were enrolled. Voices of patients undergoing LT were better in quality of voice (V0) at INFV0 scale. The scores in I-SECEL and acoustic analysis were comparable. CONCLUSIONS: Voice quality could be slight better in patients undergoing TL with voice prosthesis than those undergoing OPHL.

Adaptación y validación del Voice Handicap Index y su versión abreviada al español rioplatense de Argentina

Objetivo: Este estudio tuvo como objetivo principal validar el Voice Handicap Index (VHI) y su versión abreviada (VHI-10) adaptados al español rioplatense de Argentina, con objetivos específicos centrados en evaluar su fiabilidad y validez. Metodología: La adaptación cultural incluyó técnicas de traducción directa, síntesis y retrotraducción, evaluación de la equivalencia semántica y aplicación a un grupo piloto. Para la validación se evaluó la fiabilidad de ambos índices adaptados mediante la consistencia interna (coeficiente alfa de Cronbach) y la estabilidad test-retest (prueba de Bland-Altman, CCI y r de Spearman). Además, se examinó la validez de criterio y de constructo. 213 sujetos participaron en la validación del índice adaptado de 30 ítems (123 disfónicos; 90 de control); 113, en la del índice abreviado (63 disfónicos; 50 de control). Resultados: Se constituyó el Índice de Desventaja Vocal (IDV) como la versión adaptada del VHI al español rioplatense de Argentina. Ambos índices demostraron excelente consistencia interna (IDV-30 α = 0,96; IDV-10 α = 0,92) y estabilidad y concordancia (IDV-30 CCI = 0,95; IDV-10 CCI = 0,96). Se halló alta correlación entre los puntajes de ambos índices y la autoevaluación de la severidad de la disfonía de los participantes (r = 0,85). Ambos índices demostraron capacidad de diferenciar entre individuos con disfonía y sujetos sanos (p< 0,001). El análisis factorial reveló tres factores para el IDV-30 y un factor para el IDV-10. Conclusiones: El IDV-30 e IDV-10 presentan grados adecuados de fiabilidad y validez. Ambos pueden ser incluidos en protocolos de valoración de la función vocal por profesionales de Argentina.

Aim: This study aimed to validate the Voice Handicap Index (VHI) and its abbreviated version (VHI-10) adapted into Rioplatense Spanish from Argentina, with specific goals centered on assessing their reliability and validity. Methods: Cultural adaptation involved direct translation, synthesis and back-translation techniques, followed by an assessment of semantic equivalence and application to a pilot group. For the validation process, the reliability of both adapted indices was assessed through measures of internal consistency (Cronbach's alpha coefficient) and test-retest stability (Bland-Altman test, ICC and Spearman's correlation coefficient). Additionally, we conducted analyses to asses criterion and construct validity. 213 subjects participated in the validation of the adapted 30-items index, (123 with dysphonia; 90 from control group); 113, in the abbreviated version (63 with dysphonia; 50 from control group). Results: The "Índice de Desventaja Vocal" (IDV) was established as the adapted version of the VHI into Rioplatense Spanish from Argentina. Both indeces exhibited excellent internal consistency (IDV-30 α = 0,96; IDV-10 α = 0,92) and satisfactory stability and agreement (IDV-30 CCI = 0,95; IDV-10 CCI = 0,96). Regarding validity, a strong correlation was observed between the scores of both indeces and the participant's self-assessment of dysphonia degree (r = 0,85). Both indices effectively differentiated between individuals with dysphonia and healthy subjects (p< 0,001). Factor analysis revealed three factors for the IDV-30 and one factor for the IDV-10. Conclusion: The IDV-30 and IDV-10 demonstrate satisfactory levels of reliability and validity. Both indices can be incorporated into the assessment protocols for evaluating the vocal function by professionals in Argentina.

Surveying Colombian Speech-Language Pathologists on their Reported Training & Practices of Auditory-Perceptual Evaluation of Voice

Objective: To explore the training and use of auditory perceptual evaluation of the voice reported by Colombian speech-language pathologists. Study Design: Cross-sectional observational research with a quantitative approach. Methods: A digital questionnaire was designed and distributed to gather information regarding professionals' training process and implementation of auditory-perceptual evaluation procedures. Descriptive statistics were applied, and several generalized linear models were adjusted to determine the influence of certain variables on others. Results: The survey received responses from 40 speech-language pathologists, revealing that the most used scales for training and evaluating vocal quality within this group are direct magnitude estimations (82.5% and 77.5%). Similarly, in this group, the tasks most frequently used to train and use as an evaluation strategy are vowel assessments (38%) followed by spontaneous speech (30%). Practitioners of this group were mostly trained using a conceptual framework involving multiple exposures to rating (42.5%). The use of direct magnitude estimation in training with a normal voice showed significance (p = 0.015), as did the use of the vowel /i/ in training with an equal-appearing interval (p = 0.013). The statistical models relating the scale used to the scale on which participants were trained were also significant (p < 0.05). Conclusions: The GRBAS scale is the training tool most used by the group of speech-language pathologists of the study group in Colombia. Future efforts should focus on improving training practices for auditory-perceptual evaluation, exploring alternative conceptual frameworks, and incorporating external references to enhance validity and reliability.

Objetivo: Explorar los reportes de fonoaudiólogos colombianos acerca del entrenamiento y uso de la evaluación perceptual auditiva de la voz. Diseño de estudio: Se eligió un diseño de investigación observacional transversal con un enfoque cuantitativo. Metodología: Se diseñó y distribuyó un cuestionario digital para recopilar información sobre el proceso de formación de los profesionales y la implementación de procedimientos de evaluación perceptual auditiva. Se aplicaron estadísticas descriptivas y se ajustaron varios modelos lineales generalizados para determinar la influencia de ciertas variables en otras. Resultados: La encuesta recibió respuestas de 40 fonoaudiólogos, revelando que las escalas más utilizadas para la formación y la evaluación de la calidad vocal en el grupo son las estimaciones de magnitud directa (82.5% y 77.5%). Del mismo modo, en este grupo las tareas más frecuentemente utilizadas para la formación y el uso como estrategia de evaluación son las vocales (38%), seguidas por el habla espontánea (30%). La mayoría de los profesionales del grupo fueron formados utilizando un marco conceptual que involucra múltiples exposiciones a la calificación (42.5%). El uso de la estimación de magnitud directa en la formación con una voz normal mostró significancia (p = 0.015), al igual que el uso de la vocal /i/ en la formación con intervalos de igual apariencia (p = 0.013). Los modelos estadísticos que relacionan la escala utilizada con la escala en la que los participantes fueron entrenados también fueron significativos (p < 0.05). Conclusiones: La escala GRBAS es la herramienta de formación más utilizada por el grupo de fonoaudiólogos del estudio. Los esfuerzos futuros deberían centrarse en mejorar las prácticas de formación para la evaluación perceptual auditiva, explorar marcos conceptuales alternativos e incorporar referencias externas para mejorar la validez y la confiabilidad.

Vocal Load of University Professors: Preliminary Results

Purpose: To describe the acoustic characteristics of a classroom, voice quality, fatigue, and vocal load of university professors. Methods: Exploratory, observational, longitudinal, and descriptive study with a single group of participants, including vocal monitoring data over two weeks. Acoustic characterization of the classroom, perceptual-auditory evaluation, and acoustic analysis of voice samples were conducted before and after classes. Vocal dosimetry was performed during classes, and the Vocal Fatigue Index (VFI) was assessed at the beginning of each week. Descriptive analysis of the findings was conducted, and randomization test was performed to verify the internal reliability of the judge. Results: All participants reported speaking loudly in the classroom, with the majority reporting vocal changes in the past six months, and only one participant reported a current vocal change. The classroom had acoustical measures and estimations that deviated from established standards. The professors used high vocal intensities during classes. After the classes, an increase in the absolute values of the aggregated data for CAPE-V, jitter, and fundamental frequency was found, varying within the range of normality. Furthermore, there was an observed increase in both post-lesson intensity and VFI when comparing the two-week period. Conclusions: Vocal intensities and VFI were possibly impacted by the acoustics of the classroom. The increase in average VFI between the weeks may be attributed to a cumulative fatigue sensation. Further research with a larger number of participants and in acoustically conditioned classrooms is suggested in order to evaluate collective intervention proposals aimed at reducing the vocal load on teachers.

Objetivo: Describir las características acústicas, calidad vocal, fatiga y carga vocal de profesores universitarios. Métodos: Estudio exploratorio, observacional, longitudinal, descriptivo con un solo grupo de participantes y datos de monitoreo vocal durante dos semanas. Se realizó caracterización acústica de la sala, evaluación auditiva-perceptiva y acústica de muestras de voz antes y después de las clases. Se realizó dosimetría vocal durante las clases y se verificó el Índice de Fatiga Vocal (IFV) en dos semanas. Se realizó un análisis descriptivo de los hallazgos y una prueba de aleatorización para verificar la confiabilidad interna del juez. Resultados: Todos los participantes informaron hablar en voz alta en clase, la mayoría informó cambios vocales en los últimos seis meses y solo uno informó cambios vocales actuales. La sala presentó mediciones y estimaciones acústicas fuera de las normas establecidas. Los profesores utilizaron intensidades vocales altas durante las clases. Hubo un aumento en los valores absolutos de los datos agrupados para CAPE-V, jitter y frecuencia fundamental, variando dentro de los límites normales, después de las clases. La intensidad después de las clases y el IFV, en la comparación entre las dos semanas, mostraron un aumento. Conclusiones: La dosis vocal y el IFV posiblemente se vieron afectados por la acústica del aula. El aumento del IFV medio entre semanas pudo deberse a la sensación de cansancio acumulada. Se sugieren nuevas investigaciones con un mayor número de participantes y que se realicen en la sala acondicionada acústicamente para evaluar propuestas de intervención colectiva, con el objetivo de reducir la carga vocal de los docentes.

Impact of cochlear implants use on voice production and quality.

Cochlear implant users experience difficulties controlling their vocalizations compared to normal hearing peers. However, less is known about their voice quality. The primary aim of the present study was to determine if cochlear implant users' voice quality would be categorized as dysphonic by the Acoustic Voice Quality Index (AVQI) and smoothed cepstral peak prominence (CPPS). A secondary aim was to determine if vocal quality is further impacted when using bilateral implants compared to using only one implant. The final aim was to determine how residual hearing impacts voice quality. Twenty-seven cochlear implant users participated in the present study and were recorded while sustaining a vowel and while reading a standardized passage. These recordings were analyzed to calculate the AVQI and CPPS. The results indicate that CI users' voice quality was detrimentally affected by using their CI, raising to the level of a dysphonic voice. Specifically, when using their CI, mean AVQI scores were 4.0 and mean CPPS values were 11.4 dB, which indicates dysphonia. There were no significant differences in voice quality when comparing participants with bilateral implants to those with one implant. Finally, for participants with residual hearing, as hearing thresholds worsened, the likelihood of a dysphonic voice decreased.

The Vocal Quality of the Sender is Able to Influence the Cognitive Performance and Cortisol Level of the Listener.

OBJECTIVE: To verify the influence of the sender's vocal quality on performance in cognitive tests and on the receiver's cortisol level. STUDY DESIGN: Observational, cross-sectional, and analytical study. METHODS: Four voices were selected to represent adapted voice (AdV), and rough voice of discreet degree (DV), moderate (MV), and intense (IV). These participants recorded the stimuli used in the attention and memory tests, which included 139 undergraduate students as receivers. Saliva was collected from recipients for cortisol assessment one minute before and after 15, 30 and 45 minutes of the cognitive assessment. RESULTS: Statistically significant differences were identified between the groups in the repetition test, with worse results in IV. Cortisol increased significantly in the MV group when compared with the other groups after 15 minutes of the cognitive test. CONCLUSIONS: Emitters' rough voices can negatively influence performance in cognitive tests that require attention and working memory and leads to a short-term increase in the receiver's cortisol levels.

Exploring Interspeaker Variation in Creaky Voice in Dutch.

OBJECTIVES: This study explored the extent and discriminatory potential of interspeaker variation in creaky voice in Dutch men. METHODS: Intervals of creaky voice for 30 speakers were manually segmented and annotated from a corpus of spontaneous speech data. For each speaker, at least 1500 syllables were analyzed. Total creakiness was calculated based on the proportion of creaky syllables. Creaky intervals were categorized into subtypes based on the degree of periodicity. Furthermore, acoustic measurements were taken from the intervals and tested for speaker-discriminating capacity by means of a linear discriminant analysis (LDA). RESULTS: Speakers differed in what percentage of syllables they realized with creaky voice, with a range of roughly 0-5% of all syllables. They likewise differed in the proportion with which they used different subtypes of creaky voice, such that some speakers have very distinctive profiles. The LDA resulted in correct classifications of creaky intervals to speakers at a rate above chance level. CONCLUSIONS: Interspeaker variation in creaky voice in Dutch male speech was confirmed and allowed for moderate speaker classification on the basis of speech acoustics.

Effect of Face Masks on Voice Quality Associated with Young and Older Chinese Adult Speakers.

OBJECTIVES: Face masks have become important after the pandemic, but the change in voice when wearing a face mask is still unclear. The study investigated the effect of face masks on the acoustic and perceptual characteristics of voice quality associated with young and older Chinese adults. METHODS: Voice samples of the sustained vowel /a/ and continuous speech produced by 44 older and 61 young adults with and without an ASTM level-3 surgical face mask were recorded and analyzed. Perceptual and acoustic parameters including mean fundamental frequency (F0) and intensity, perturbation measures (jitter and shimmer), harmonic-to-noise ratio (HNR), smoothed cepstral peak prominence (CPPs), and long-term average spectrum (LTAS) measures were obtained and compared. RESULTS: When comparing masked to unmasked voices, for both male and female speakers, F0 and intensity showed no significant changes, except for F0 of continuous speech, which increased significantly. Meanwhile, perturbation measures such as jitter and shimmer were reduced, while HNR and CPPs increased. In addition, LTAS measures included low-frequency mean spectral energy (MSE), high-frequency MSE, and spectral tilt (ST), which were different. For perceptual measures, the overall grade of dysphonia, and roughness were reduced, except for the breathiness among older male speakers, while the other vocal qualities were not changed. Between young and older speakers, significant differences in shimmer, CPPs, and perceived breathiness among male speakers, and low-frequency MSE among female speakers were found. CONCLUSION: Wearing a surgical mask appeared to change the perceived voice quality. This is supported by the change in perturbation and LTAS measures, and HNR and CPPs values. In addition, some differences between young and older adults were observed. Oral Communication effectiveness may be affected when wearing surgical masks due to changes in voice quality. Additionally, clinicians need to exercise hightened caution in evaluating the voice quality of clients when wearing face masks.

A lecturer's voice quality and its effect on memory, listening effort, and perception in a VR environment.

Many lecturers develop voice problems, such as hoarseness. Nevertheless, research on how voice quality influences listeners' perception, comprehension, and retention of spoken language is limited to a small number of audio-only experiments. We aimed to address this gap by using audio-visual virtual reality (VR) to investigate the impact of a lecturer's hoarseness on university students' heard text recall, listening effort, and listening impression. Fifty participants were immersed in a virtual seminar room, where they engaged in a Dual-Task Paradigm. They listened to narratives presented by a virtual female professor, who spoke in either a typical or hoarse voice. Simultaneously, participants performed a secondary task. Results revealed significantly prolonged secondary-task response times with the hoarse voice compared to the typical voice, indicating increased listening effort. Subjectively, participants rated the hoarse voice as more annoying, effortful to listen to, and impeding for their cognitive performance. No effect of voice quality was found on heard text recall, suggesting that, while hoarseness may compromise certain aspects of spoken language processing, this might not necessarily result in reduced information retention. In summary, our findings underscore the importance of promoting vocal health among lecturers, which may contribute to enhanced listening conditions in learning spaces.

Voice Changes of Patients With Nasopharyngeal Carcinoma in Eleven Years After Radiotherapy: A Cross-Sectional Study.

OBJECTIVES: The objective of this study was to assess voice changes in patients with nasopharyngeal carcinoma (NPC) using subjective and objective assessment tools and to make inferences regarding the underlying pathological causes for different phases of radiotherapy (RT). METHODS: A total of 187 (123 males and 64 females) patients with post-RT NPC with no recurrence of malignancy or other voice diseases and 17 (11 males and 6 females) healthy individuals were included in this study. The patients were equally divided into 11 groups according to the number of years after RT. The acoustic analyses, GRBAS (grade, roughness, breathiness, asthenia, and strain) scales, and Voice Handicap Index (VHI)-10 scores were collected and analyzed. RESULTS: The fundamental frequency (F0) parameters in years 1 and 2 and year 11 were significantly lower in patients with NPC than in healthy individuals. The maximum phonation times in years 1 and 11 were significantly shorter than those in healthy individuals. The jitter parameters were significantly different between year 1 and from years 8 to 11 and the healthy individuals. The shimmer parameters were significantly different between years 1, from years 9 to 11, and healthy individuals. Hoarseness was the most prominent problem compared to other items of the GRBAS. The VHI-10 scores were significantly different between years 1 and 2 and year 11 after RT in patients with NPC. CONCLUSIONS: Voice quality was worse in the first 2 years and from years 8 to 11 but remained relatively normal from years 3 to 7 after RT. Patient-reported voice handicaps began during year 3 after RT. The most prominent problem was perceived hoarseness, which was evident in the first 2 years and from years 9 to 11 after RT. The radiation-induced mucous edema, laryngeal intrinsic muscle fibrosis, nerve injuries, upper respiratory tract changes, and decreased lung capacity might be the pathological reasons for voice changes in post-RT patients with NPC.