Development of a Voice Handicap Index for Clergymen: An Investigation of Its Validation and Reliability.

OBJECTIVE: This study aims to is to develop a disorder-specific patient-reported outcome measure to be used in Islamic clergymen with voice disorders and to investigate its validity and reliability. METHODS AND PROCEDURES: Employing an exploratory sequential mixed-methods design, this study conducted in two phases. Initially, semistructured interviews were conducted with 10 clergymen experiencing voice disorders. Subsequently, the questionnaire underwent rigorous validation, encompassing content, construct, and criterion validity assessments, in addition to test-retest reliability and internal consistency analyses. The index was administered to a sample of 110 male clergy, including imams, muezzins, and Quran course teachers, with an age range from 19 to 61years. RESULTS: Construct validity was established through factor analysis, resulting in a final 23-item scale categorized into two factors: physical-functional and emotional. Known group validity demonstrated a significant distinction between the study and control groups. Criterion validity reinforced the index's validity, displaying a correlation coefficient of 0.758 between the Voice Handicap Index for Clergymen and the well-established Voice Handicap Index. The questionnaire exhibited commendable internal consistency, with a Cronbach's Alpha (α) coefficient value of 0.971. Test-retest reliability analysis exhibited strong consistency, with a Pearson correlation coefficient of 0.863. CONCLUSIONS: It is recommended that the developed valid and reliable handicap index in the present study be included in the voice assessment batteries of Islamic clergymen with voice complaints with the clinical and research purposes. In future studies, the validity of the questionnaire can be investigated more by examining the difference between the Voice Handicap Index for Islamic Clergymen (CVHI) scores obtained before and after treatment. Identifying a cut-off point that discriminates between dysphonic and normophonic clergymen may allow the use of the CVHI as a screening tool for this population.

Validity and Reliability Study of the Turkish Version of Focus on the Outcomes of Communication Under Six-34.

PURPOSE: Speech and language disorders can negatively affect preschool children's communicative participation skills. Focus on the Outcomes of Communication Under Six-34 (FOCUS-34) is a valid and reliable scale that evaluates communicative participation in preschool children with speech and language disorders. This study aimed to establish the Turkish version of FOCUS-34 (FOCUS-34-TR) and investigate its validity and reliability. METHOD: A total of 175 children with language disorders, speech sound disorders, and fluency disorders (aged 20-72 months) and their parents were included in the study. Parents were asked to complete the demographic information form, the FOCUS-34-TR scale, and the Ages and Stages Questionnaires: Social-Emotional (ASQ-SE) Turkish version. The construct validity, convergent and divergent validity, internal consistency, and test-retest reliability of the scale were investigated. RESULTS: The FOCUS-34-TR had high values for internal consistency (α = .97) and test-retest reliability (r = .95). The correlations between the FOCUS-34-TR total score and its subscales were between .77 and .90. A moderately significant negative correlation was found between the FOCUS-34-TR scale and the ASQ-SE. CONCLUSION: The Turkish version of FOCUS-34 is a valid and reliable scale that can be used in clinics and for research purposes to evaluate the communicative participation skills of Turkish-speaking preschool children with speech and language disorders.

Psychometric properties of the Viking Speech Scale-Turkish version for children with cerebral palsy aged 4-18 years based on live and video-based observation.

BACKGROUND: Speech is the most common method of communication. Video-based clinical communication evaluation is a requirement for children with speech-language impairments living in rural areas, and those who have limited mobility. AIMS: To determine the validity and reliability of the Turkish version of the Viking Speech Scale (VSS-T) via live and video-based observation for children with cerebral palsy (CP) aged 4-18 years. METHODS & PROCEDURES: A total of 142 children (mean age 8.18 ± 3.98 years; 68 female) with CP were included in this study. Their motor, communication, visual and eating-drinking function levels and comorbidities (dental, swallowing, cognitive impairments and epilepsy) were recorded. The Intelligibility in Context Scale (ICS), the Pediatric Evaluation of Disability Inventory-Social Function (PEDI-SF), and the Functional Independence Measure for Children-Communication (WeeFIM-C) were assessed to examine the concurrent validity of the VSS-T. The interrater reliability of the VSS-T was analysed between parents, physical therapists, and speech and language therapists from live and video-based observation. Intra-rater reliability was calculated from ratings made from live and video-based observations taken 3 weeks apart. OUTCOMES & RESULTS: The VSS-T was strongly related to the ICS (r = -0.830), PEDI-SF (r = -0.819), WeeFIM-C (r = -0.643), other functional classifications (r > 0.432), and the comorbidities (Cramer's V > 0.284, p < 0.001). Good to excellent interrater reliability (κw ≥ 0.838) and intra-rater reliability (intraclass correlation coefficient (ICC) = 0.848-0.995) were found between parents and therapists. CONCLUSIONS & IMPLICATIONS: Speech and language therapists, physical therapists, and parents can use the VSS-T as a valid and reliable classification system to describe speech intelligibility of 4-18-year-old children with CP. Both live and video-based observations can be used to administer the VSS-T. WHAT THIS PAPER ADDS: What is already known on the subject The English version of the VSS has been shown to be a valid and reliable tool used to classify the speech of children with CP aged 4-13 years. The scale can be administered by means of live observation of the child or based on clinicians' notes on the case by parents, SLTs, physiotherapists and paediatricians. What this paper adds to existing knowledge The VSS-T is valid and reliable for children with CP aged 4-18 years. Video-based observation is a suitable method for evaluating the VSS-T levels. The VSS-T has a moderate association with the CFCS. What are the potential or actual clinical implications of this work? The VSS-T is a valid and reliable method of categorizing the severity of motor speech impairment for Turkish children with CP in clinical research studies, registry systems or epidemiological studies. Both experienced and inexperienced therapists can use either live or video-based observation methods to administer the VSS-T. This study extended the validity and reliability of the scale in children with CP aged up to 18 years. The VSS-T is also associated with the Visual Functional Classification System (VFCS), which has been recently developed for describing the visual abilities of children with CP in daily life. In addition, the VSS-T is associated with the presence of dental, swallowing, cognitive problems and epilepsy.

Vocal outcomes after COVID-19 infection: acoustic voice analyses, durational measurements, self-reported findings, and auditory-perceptual evaluations.

PURPOSE: The ongoing literature suggests that COVID-19 may have a potential impact on voice characteristics during the infection period. In the current study, we explored how the disease deteriorates different vocal parameters in patients who recovered from COVID-19. METHODS: A total of 80 participants, 40 patients with a prior history of COVID-19 (20 male, 20 female) with a mean age of 39.9 ± 8.8 (range, 21-53) and 40 gender and age-matched healthy individuals (mean age, 37.3 ± 8.8; range, 21-54) were included to this study. The data of acoustic voice analyses, durational measurements, patient-reported outcomes, and auditory-perceptual evaluations were compared between the study group and the control group. Correlation analyses were conducted to examine the association between the clinical characteristics of the recovering patients and measured outcomes. RESULTS: Maximum phonation time (MPT) and the scores of both Voice Handicap Index-10 (VHI-10) and Voice-Related Quality of Life (V-RQOL) questionnaires significantly differed between the groups, which was more evident in female participants. The overall severity score of dysphonia was found to be higher in the study group than the control group (p = 0.023), but gender-based comparisons reached significance only in males (p = 0.032). VHI-10 and V-RQOL revealed significant correlations with the symptom scores of the disease. CONCLUSIONS: Patients with a prior history of COVID-19 had significantly lower MPT, increased VHI-10 scores, decreased voice-related quality of life based on the V-RQOL questionnaire, and higher overall severity scores in the auditory-perceptual evaluation. Self-reported voice complaints disclosed close relationships with the symptom scores of COVID-19 disease.

The Adaptation of Developmental Sentence Scoring and Index of Productive Syntax to Turkish.

PURPOSE: Language sampling analysis (LSA) plays an important role in evaluating language skills; hence, the study aimed to develop new assessment measures for the LSA in Turkish as alternatives to mean length of utterance (MLU) and the Language Assessment, Remediation and Screening Procedure. With this aim, Developmental Sentence Scoring (DSS) and the Index of Productive Syntax (IPSyn) were adapted to Turkish. METHOD: Eighty monolingual Turkish children were included in the study, and the age range was from 2;0 to 5;11 (years;months). The children were grouped with 6-month intervals, and each group had an equal number of participants in terms of gender. Their general and language development were tested with standardized tests, and language sampling was recorded during play with farm toys for 15-20 min. Reviewing literature and observing participants' production schemas were created for DSS for Turkish (DSS-TR) and the IPSyn for Turkish (IPSyn-TR) separately, and final versions were determined in consultation with experts. RESULTS: DSS-TR and IPSyn-TR were significantly correlated with standardized tests, and MLU values were statistically significant (p < .05). Total scores increased with age; however, grammatical categories did not go up. No difference was observed between genders (p > .05). In DSS-TR, the "sentence point" did not affect the participants' total scores because of language characteristics (p > .05). Finally, DSS-TR and IPSyn-TR were seen to be correlated with each other (p < .05). CONCLUSIONS: DSS-TR and IPSyn-TR are valid, being correlated with other assessment tools, and reliable, showing a high correlation with other raters, to reflect morphosyntactic skills. Therefore, they both are alternative assessment measures that will be used in LSA and give an opportunity to clinicians to plan their intervention goals. Also, they enable clinicians to observe progress not only specific to grammatical category but also in the total scores of the children either during or at the end of the therapy.

Development, Validation, and Reliability of the Teacher-Reported Pediatric Voice Handicap Index.

PURPOSE: The purpose of this study was to develop a novel teacher-reported pediatric voice outcome measure and to investigate its psychometric properties. METHOD: In the first stage, a new instrument, the Teacher-Reported Pediatric Voice Handicap Index (TRPVHI), was developed. After item generation, a panel of experts evaluated the items to assess the content validity. Subsequently, the final version of the preliminary instrument was applied to teachers of 306 children (57 dysphonic and 249 vocally healthy) between the ages of 4 and 11 years. Eventually, the construct validity, criterion-related validity, test-retest reliability, and internal consistency of the developed instrument were examined. RESULTS: The items with a content validity ratio less than .8 were modified or removed, and accordingly, the preliminary version of the index was finalized. After the application of the preliminary version, item reduction was made based on the factor analysis. The index is composed of 27 questions and three subscales: Functional, Physical, and Emotional. A significant difference was observed between the dysphonic and vocally healthy children for the TRPVHI scores (p < .001). A positive moderate correlation was determined between the Pediatric Voice Handicap Index and TRPVHI scores. Correlation coefficients between the test and retest scores of the TRPVHI were in the range of .92-.98. Cronbach's alpha values computed to assess the internal consistency were in the range of .94-.98. CONCLUSIONS: The TRPVHI is the only valid and reliable teacher-reported outcome measure of the effects of voice disorders on children. It is anticipated that the deployment of the TRPVHI in conjunction with other subjective tools, both in the initial evaluation and the follow-up of the treatment results, will allow a better understanding of the physical, functional, and emotional effects of voice disorders on children. Furthermore, it can potentially lead further research to enable the use of the TRPVHI for screening purposes.

Investigating Validity and Reliability of the Turkish Version of Transsexual Voice Questionnaire (Male to Female).

OBJECTIVE: The problems faced by trans women with regard to their voice may affect their quality of life. For the evaluation of trans women's voice, tools assessing their self-perception are very important, with the Transsexual Voice Questionnaire (TVQMtF ) being one of the most frequently used. The purpose of this study was to investigate the validity and reliability of the Turkish version of the TVQMtF (TVQMtF -TR), which was previously translated into 12 languages. STUDY DESIGN: Cross-sectional study. METHOD: A total of 41 trans women participated in this study. The participants filled out the TVQMtF -TR, the self-perceptions of voice femininity questionnaire, and the World Health Organization Quality of Life Questionnaire-Short Form (WHOQOL-BREF-TR). Additionally, 58.5% of the participants filled out the TVQMtF -TR again two weeks after the first interview. RESULTS: The total Cronbach's-α value of the TVQMtF -TR was 0.972, and the item-total correlation values were found to be between 0.323 and 0.876. The intraclass correlation coefficient value was 0.931. There was a strong negative correlation between TVQMtF -TR and self-perceptions of voice femininity. There was a significant negative correlation between TVQMtF -TR and the psychological and environmental domains of WHOQOL-BREF-TR. However, there was no significant relationship found between the social and physical domains. CONCLUSION: According to the results of the study, the Turkish version of TVQMtF -TR was considered a valid and reliable tool.

Investigation of the effect of Hanen's "More Than Words" on parental self-efficacy, emotional states, perceived social support, and on communication skills of children with ASD.

BACKGROUND: Parents' emotional states, self-efficacy, and perceived social support levels are crucial elements to consider when planning treatments for children with autism spectrum disorders (ASD). High levels of parental stress, depression, anxiety and low levels of parental efficacy and social support may disrupt the role of parent involvement in early intervention programs. In this study, Hanen's "More Than Words" (HMTW) intervention was provided to a group of parents with children who had been diagnosed early with ASD. METHOD: Fourteen parents and their children with ASD (four girls and ten boys) were enrolled in the study. The primary impact of the HMTW intervention on parents' emotional states, self-efficacy, interactional behaviors, and perceived social support levels and its secondary effect on children's communication development was investigated in five different time intervals and in three different conditions (pre-intervention, post-intervention, and follow-up). RESULTS: The results indicated that the rate of change in the levels of parents' self-efficacy, state of anxiety, parental stress, parental interactional behaviors, and childrens' verbal language performances and interactional behaviors was statistically different in the post-intervention period when compared with the pre-intervention period (p < .05). CONCLUSIONS: The HMTW intervention did not only have a positive effect on parents, but also on children with ASD in this study. WHAT THIS PAPER ADDS: This research was an extension of the previous "Hanen's More Than Words" efficacy studies to examine the program's primary effect on parents' emotional states, self-efficacy, interactional behaviors, and perceived social support levels and its secondary effect on children's interactional behavior and language development. The findings of the study confirm that the program has the potential to increase parents' sense of efficacy and the quality of parent-child interactions. The main conclusion is that parents, as the main caregivers, should be involved in the treatment of their young children with ASD.

Turkish stimulability treatment program for children with speech sound disorders: a preliminary study.

PURPOSE: The objective of this study was to create a stimulability treatment program in Turkish language that targets Turkish consonants and vowels and to present the preliminary findings of the effectiveness of the program in a small group of Turkish children with speech sound disorder (SSD). METHOD: Twenty-two children with SSD participated in the study. The Turkish Articulation and Phonology Test (SST) was used in the assessment of children. Intelligibility ratings were completed by their caregivers through the Turkish version of Intelligibility in Context Scale (ICS), and the stimulability assessments were completed. Stimulability intervention were given for a total of 12 sessions. Comparisons were made between the pre- and post-test results of children, and the preliminary data of treatment efficacy were collected. RESULTS: The data analysis showed a significant difference in the total number of articulation errors of children between Time 1 and Time 2 (p < .0001), a statistically significant difference in auditory discrimination scores between the two measurements, (p < .05), and an increase in stimulability ratings from Time 1 to Time 2. CONCLUSION: These findings provide initial data on the positive effect of the Turkish stimulability treatment program for children with SSD. This preliminary study would contribute toward designing the main trial for an evidence-based study for the Turkish stimulability treatment program, thereby leading to better practices in SSD.

Reliability and Validity of the Turkish Reflux Symptom Index.

OBJECTIVE: To validate and assess reliability of the Turkish Reflux Symptom Index (T-RSI). STUDY DESIGN: Cross-sectional case-control study. MATERIALS AND METHODS: A Turkish version of the original American English RSI was developed. One hundred thirty-two patients with a Reflux Finding Score (RFS) > 7, and 162 healthy controls (HC) with RFS ≤7 were included in the study. To assess reliability, the T-RSI was scored twice, within a 7-14 day window. For construct validity, the scores obtained in the study group were compared to the scores from the HC group. A correlation between RSI and RFS was assessed to determine content validity. Finally, sensitivity and specificity of the index was calculated using a receiver operating characteristic curve analysis. RESULTS: The T-RSI showed excellent internal consistency (Cronbach`s α = 0.912). Item-total correlation coefficients ranged between 0.572 and 0.773. The Pearson product-moment correlation test indicated that the T-RSI is a reliable tool (r = 0.931, n = 107, P < 0.001). There were significant difference between the study group and the HC group for the mean RSI scores (18.15 ± 7.31 and 7.88 ± 5.32, P < 0.001 respectively). The mean RFS score in the patients was 12.57 and the correlation between RFS score and RSI score was high (r = 0.704). According to the receiver operating characteristic curve analysis the area under curve of the T-RSI was 0.892. The optimal cut-off value was 12.5 with a sensitivity of 82.6% and a specificity of 84.6%. CONCLUSION: The T-RSI is an easily administered, reliable, and valid instrument for assessing symptoms thought to be related to laryngopharyngeal reflux. A score of T-RSI greater than 12.5 is similar to an RSI score of >13 considered symptomatic for laryngopharyngeal reflux.

The Effects of Age and Gender on Laryngeal Aerodynamics in the Children Population.

OBJECTIVES: Normal voice can be differentiated from dysphonic voices by comparing their characteristics using an established normative database. Pediatric normative data using the Phonatory Aerodynamic System (PAS) have been established in a preliminary study for English-speaking children. However, aerodynamic measures, including physical characteristics varying by geographic region, race, and culture, must be investigated between children with different native languages. Aerodynamic analysis of connected speech requires the collection of language-specific samples and the establishment of language-specific norms. Thus, the main purpose of the present study was to establish pediatric normative data using the PAS for a large pediatric population of healthy Turkish-speaking children of 4-17.11 years of age. Another research aim was to determine age-dependent and/or gender-dependent aerodynamic parameters for this pediatric population. METHODS: In total, 120 children were divided into four age groups: Group I, 4-5.11 years; Group II, 6-9.11 years; Group III, 10-13.11 years; and Group IV, 14-17.11 years. An equal number of male and female participants were assigned to each group. The PENTAX Medical PAS Model 6600 was used. Descriptive statistics for 56 parameters across six protocols were expressed as mean, standard deviation, and range values. Each protocol was analyzed for age, gender, and age-gender interaction. RESULTS: Age was the most predominant factor, affecting 37 of the 56 aerodynamic parameters investigated. Gender and age-gender factors were observed at an equal frequency, each affecting 16 parameters. Pitch-related parameters were the most altered parameters in each protocol. Age-gender interaction was observed in parameters related to the expiratory airflow. CONCLUSIONS: This study established the normative values of phonatoary aerodynamics for a large pediatric population with a wide age range and developed a normative database for healthy Turkish-speaking children. This is the first study to investigate running speech protocol in aerodynamic assessment.

Investigation of the Effectiveness of a Holistic Vocal Training Program Designed to Preserve Theatre Students' Vocal Health and Increase Their Vocal Performances; A Prospective Research Study.

OBJECTIVE: The main purpose of this study is to investigate the effectiveness of a 12-week holistic vocal training program designed for theatre students. METHODS: The participants included 10 female and 8 male students, who were third- and fourth-year students of a state conservatory theatre department. Participants randomly selected from among those who were between the ages of 18-30 years, had no history of voice disorders, and had no systemic and neurological disorders. The study group (n = 9) was involved in the vocal training program. The control group (n = 9) has not received any training. During the program, 12 sessions of lectures and voice exercises were given to all participants of the study group for a period of 12 weeks. The sessions were planned to last for a duration of 30-45 minutes. Participants' knowledge of vocal health was assessed using a questionnaire that was developed in the present study and a multidimensional voice assessment protocol including acoustic analyses and audio-perceptual evaluation has been applied. RESULTS: Within-group comparisons indicated a significant increase in the study group participants' knowledge of vocal hygiene after training (P = 0.011). Similarly, the study group outperformed the control group in the vocal mechanism knowledge (P = 0.027). Multidimensional Voice Profile findings revealed that vocal qualities of the control group deteriorated, whereas no alterations were found in the study group. Audio-perceptual analysis conducted through the Consensus Auditory-Perceptual Evaluation of Voice did not introduce significant changes in the control group in overall severity and roughness parameters, these values were found significantly improved for the study group. CONCLUSION: It can be concluded that the Holistic Vocal Training Program designed in the present study is effective for preserving theatre students' vocal health and voice quality. It is important for future studies to search the long-term effects.

Validity and Reliability of the Turkish SingingVoice Handicap Index-10.

OBJECTIVE: To evaluate the validity and reliability of the Turkish version of the Singing Voice Handicap Index-10 (SVHI-10). STUDY DESIGN: Cross-sectional study. METHODS: Two hundred singers consisting of a control group (n = 136) without voice complaints and a study group (n = 64) diagnosed with a voice disorder served as participants. To detect test-retest reliability, 97 participants (representing a portion of both the control and study group participants) completed the index twice with a minimum of a one-week interval between each completion. Internal consistency was confirmed using Cronbach's alpha coefficient. To complete a clinical validity assessment, scores from the control group participants were compared with scores from the study group participants. To determine content validity, the correlation between the SVHI-10 and the participants' perceptions of singing voice complaints was researched. The sensitivity and specificity of the SVHI-10/Turkish version were calculated using a receiver operating characteristic curve analysis. RESULTS: Cronbach's alpha coefficient, which was equal to 0.91, proved to have excellent internal consistency. Item-total correlations were found in the range of 0.55 to 0.76. The mean SVHI-10/Turkish score for the control group was 8.14 ± 5.4, whereas this value was significantly higher in the study group (20.54 ± 6.9, P < 0.001). The Pearson product-moment correlation test indicated that the Turkish SVHI-10 is a reliable tool (r = 0.90, n = 97, P < 0.001). The area under curve of the Turkish SVHI-10 was 0.95. The optimal cut-off point was found to be 11.5, with a sensitivity of 95.8% and a specificity of 83.2%. CONCLUSIONS: The Turkish version of the SVHI-10 has proven to be a reliable and valid instrument for evaluating the self-perception of a singer in relation to voice problems. It can also be used as a quick screening tool because a score on the SVHI-10 higher than 11.5 is indicative of an abnormal singer's perceived voice handicap.

Analysis of behavioural characteristics of children with developmental language disorders.

Purpose: Developmental language disorder (DLD) is common in early childhood and there may be an increased risk of co-occurring social, emotional, and behavioural problems related to the language problems of children. The aim of this study was to determine whether children with DLD experience more emotional and/or behavioural problems as compared to their typically developing peers.Method: A prospective case-control study design was used to perform a comparison between children with DLD and their typically developing peers. Thirty-eight Turkish children with DLD (mean age 38.21 months, standard deviation 8.15 months) and 30 Turkish children with typical language development (mean age 37.03 months, standard deviation 9.01 months) participated in the study.Result: The results of the analysis indicate that children with DLD have significantly higher scores for emotional reactivity, anxiety/depression, somatic complaints, withdrawnness, sleep problems, attention problems, and aggressive behaviours as compared with their typically developing peers.Conclusion: This study provides evidence to support children with DLD being at risk of other emotional and/or behavioural problems. An in-depth analysis of the behavioural characteristics of these children may be required to prevent and/or reduce the co-occurrence of other problems.

Use of cepstral analysis for differentiating dysphonic from normal voices in children.

OBJECTIVES: Cepstral measures have mainly been evaluated by studies conducted on dysphonic and healthy adults, and many of these studies have reported the advantages of using cepstral measures for the evaluation of dysphonia however there is a paucity regarding to the cepstral analyses' results in dysphonic children. In this present study, it is hypothesized that cepstral peak prominence (CPP) and some other parameters of cepstral analysis would differ in children with vocal nodules when compared with the same parameters of cepstral analysis of healthy children. METHODS: In this present study, totally 54 children aged between 5 years old to 12 years and 7 months participated. The study group consisted of 20 males and 7 females diagnosed with vocal nodules. The control group consisted of an equal number of age- and gender-matched healthy peers. Analysis of Dysphonia in Speech and Voice software (CSL Model 4500 equipment, Kay Elemetrics Group) was used to gather speech sample recordings according to the Consensus Auditory-Perceptual Evaluation of Voice/Turkish protocol. Cepstral measures of all the six CAPE-V sentences and sustained/a/sample were calculated. CPP, CPP fundamental frequency, CPP standard deviation (CPP SD), Low_high spectral ratio (L/H ratio), L/H ratio standard deviation parameters were taken into account when statistical analyses were completed. In addition to the descriptive statistics of ceptral measures for both groups, the differences between the study and control groups according to the gender were documented. RESULTS: It was found that for both genders CPP and CPP SD values were significantly higher for the control group for vowel-weighted sample, all voiced-weighted sample, glottal attack-weighted sample, nasal weighted sample, and voiceless-weighted sample. In the vowel-weighted sample, CPP and CPP SD were significantly higher for the control group in males. In females, a difference was only observed on the CPP parameter for the same sentence. In terms of the CPP value of the sustained phonation sample, a significant difference was only detected for males, whereas no difference was detected for females. CONCLUSIONS: In conclusion, present study found that cepstral analysis can be used to determine the difference between dysphonic and healthy voices of children and indicated that cepstral analysis should be a compulsory component of routine clinical voice evaluation of children. In addition, this present study indicates that of the cepstral analysis of sentences appear to be more sensitive to dysphonia than the analysis of vowel samples. In future studies, normative values of the CAPE-V/Turkish sentences and cutoff values for differentiating dysphonia from normal voice should be evaluated using a larger sample size.

Reliability and Validity of the Turkish Version of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V).

OBJECTIVES: The main purpose of this study was to culturally adapt the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) to Turkish and to evaluate its internal consistency, validity, and reliability. MATERIALS AND METHODS: The Turkish version of CAPE-V was developed, and with the use of a prospective case-control design, the voice recordings of 130 participants were collected according to CAPE-V protocol. Auditory-perceptual evaluation was conducted according to CAPE-V and Grade, Roughness, Breathiness, Asthenia, and Strain (GRBAS) scale by two ear, nose, and throat specialists and two speech and language therapists. The different types of voice disorders, classified as organic and functional disorders, were compared in terms of their CAPE-V scores. RESULTS: The overall severity parameter had the highest intrarater and inter-reliability values for all the participants. For all four raters, the differences in the six CAPE-V parameters between the study and the control groups were found to be statistically significant. Among the correlations for the comparable parameters of the CAPE-V and the GRBAS scales, the highest correlation was found between the overall severity-grade parameters. There was no difference found between the organic and functional voice disorders in terms of the CAPE-V scores. CONCLUSIONS: The Turkish version of CAPE-V has been proven to be a reliable and valid instrument to use in the auditory-perceptual evaluation of voice. For the future application of this study, it would be important to investigate whether cepstral measures correlate with the auditory-perceptual judgments of dysphonia severity collected by a Turkish version of the CAPE-V.

Turkish Standardized Reading Passage for the Evaluation of Hard Glottal Attack Occurrence Frequency.

OBJECTIVE: This study aimed to develop a Turkish reading passage that can be used in evaluating the frequency of hard glottal attack (HGA) and to assess its reliability. STUDY DESIGN: This is a prospective case-control study. METHODS: The Towne-Heuer reading passage is a valuable tool that can be used for the auditory-perceptual assessment of voice. The characteristics of the first four paragraphs of the reading passage were analyzed by a linguist. Then, a Turkish reading passage with similar characteristics was developed. The control group (n = 21) consisted of individuals with no voice disorder. The study group consisted of two subgroups that were diagnosed as having vocal fold nodules (n = 11) and muscle tension dysphonia (n = 10). A total of three listeners were evaluated for the frequency of HGAs. One of the listeners was a master's student, whereas the other two listeners were speech-language pathologists. Consistency between the listeners was evaluated by using the percent agreement and the kappa statistics. Intrarater reliability was assessed by the Wilcoxon sign test. The t test was used to evaluate potential differences between the groups. The results were considered as significant if the P value was <0.05. RESULTS: The average attack number in the study group was found to be significantly higher than the controls (P < 0.05). No significant difference could be discerned between the muscle tension dysphonia and vocal nodule subgroups (P > 0.05). CONCLUSIONS: Findings confirmed that HGAs are clearly related to the vocal hyperfunction; however, the mechanism of action needs more research. In addition, the relationship between syllable stress and HGA should be further researched to clarify the cause of the attack number differences between English and Turkish languages.

Investigating the Effects of Glottal Stop Productions on Voice in Children With Cleft Palate Using Multidimensional Voice Assessment Methods.

OBJECTIVES: The aim was to investigate the effects of glottal stop productions (GS) on voice in children with cleft palate using multidimensional voice assessment methods. STUDY DESIGN: This is a prospective case-control study. METHODS: Children with repaired cleft palate (n = 34) who did not have any vocal fold lesions were separated into two groups based on the results of the articulation test. The glottal stop group (GSG) consisted of 17 children who had GS. The control group (CG) consisted of an equal number of age- and gender-matched children who did not have GS. The voice evaluation protocol included acoustic analysis, Pediatric Voice Handicap Index (pVHI), and perceptual analysis (Grade, Roughness, Breathiness, Asthenia, Strain method). The velopharyngeal statuses of the groups were compared using the nasopharyngoscopy and the nasometer. RESULTS: The total pVHI score and the subscales of the pVHI were found to be significantly higher in the GSG. The F0, jitter, and shimmer were found to be numerically higher in the GSG with the difference being statistically significant in jitter (P < 0.05). Audioperceptual analysis revealed a difference in overall voice quality and roughness between the groups. Greater incidence of significant velopharyngeal insufficiency and higher nasalance scores were found in the GSG (P < 0.05). CONCLUSIONS: These results may indicate that the vocal quality characteristics of children with GS differ from children who do not have this type of production. It is suggested that children with cleft palate who have GS should receive a comprehensive speech and language pathology intervention including voice therapy techniques.

Evaluation of hearing and speech-language in preschool children: how important, why we should perform?

The aim of the study was to present the hearing and speech-language findings of preschool children. The children in this study were aged 3-5 years. Sixtyseven of 239 children (28.0%) had been referred to a physician because of possible middle ear problems, and 25 of the 67 children had slight and mild conduction type hearing loss with air-bone gaps. One of 239 children had profound sensorineural hearing loss. Speech-language problems were found in 70 of 239 children (29.3%). Necessary attention should be paid to the evaluation of hearing and speech-language skills in preschool-aged children to avoid delayed detection and to give these children the opportunity for timely intervention for hearing and speech-language problems.

Evaluation of visual motor perception in children with developmental articulation and phonological disorders.

The aim of this study is to compare the visual-motor perceptual skills of children who have a developmental articulation and phonological disorder, with children who do not have such disorders. A group of 21 children between the ages 5:6 and 9:1 yr. (13 boys, 8 girls) was compared to a control group of 21 children matched on sex, age, and socioeconomic level using the Bender Visual-Motor Gestalt Test. Children with disorders had significantly more Bender errors.