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.

Listening effort, fatigue, and streamed voice quality during online university courses.

Understanding the impact of listening effort (LE) and fatigue has become increasingly crucial in optimizing the learning experience with the growing prevalence of online classrooms as a mode of instruction. The purpose of this study was to investigate the LE, fatigue, and voice quality experienced by students during online and face-to-face class sessions. A total of 110 participants with an average age of 20.76 (range 18-28) comprising first year undergraduate students in Speech and Language Therapy and Audiology programs in Turkey, rated their LE during the 2022-2023 spring semester using the Listening Effort Screening Questionnaire (LESQ) and assessed their fatigue with the Multidimensional Fatigue Inventory (MFI-20). Voice quality of lecturers was assessed using smoothed cepstral peak prominence (CPPS) measurements. Data were collected from both online and face-to-face sessions. The results revealed that participants reported increased LE and fatigue during online sessions compared to face-to-face sessions and the differences were statistically significant. Correlation analysis showed significant relationships (p < 0.05) between audio-video streaming quality and LE-related items in the LESQ, as well as MFI sub-scales and total scores. The findings revealed a relationship between an increased preference for face-to-face classrooms and higher levels of LE and fatigue, emphasizing the significance of these factors in shaping the learning experience. CPPS measurements indicated a dysphonic voice quality during online classroom audio streaming. These findings highlight the challenges of online classes in terms of increased LE, fatigue, and voice quality issues. Understanding these factors is crucial for improving online instruction and student experience.

Exploring the Role of Opera Voice Quality Exercise in the Voice Therapy.

OBJECTIVE: There are very diverse approaches for voice therapy, and the application of voice quality used in vocal arts in voice therapy can also be seen. However, there is little research on the application of opera voice quality in voice therapy. This study explored the applications of our Opera Voice Quality Exercise in the field of voice therapy and investigated the impacts of this exercise on pitch, intensity, voice quality, and vocal ability. METHODS: Sixty-two healthy subjects, defined as those with no discomfort in their voice and no appearance of organic lesions on the larynx via stroboscopic laryngoscopy were included in the study. The subjects were randomly divided into an experimental group of 31 subjects and a control group of 31 subjects. The experimental group received a voice health education and weekly coaching sessions of Opera Voice Quality Exercise, whereas the subjects in the control group only had the former. The acoustic and aerodynamic parameters were evaluated before and after the experimental interventions. RESULTS: When producing [a] at comfortable speech pitch and intensity, the experimental group compared to the control group showed statistically significant improvement (P < 0.05) in the irregularity component (IC) parameter for males. When producing [a] at loudest intensity at a higher pitch in the normal speech pitch range, the experimental group compared to the control group showed statistically significant increase (P < 0.01) in sound pressure level (SPL) as well as improvements (P < 0.05) in shimmer and IC parameters for males. There was a statistically significant increase (P < 0.05) in SPL for females. During continuous speech, the experimental group compared to the control group showed statistically significant increase (P < 0.01) in SPLmax (maximum sound pressure level) for both males and females. There was a statistically significant increase in highest pitch (P < 0.01) and lowest pitch (P < 0.05) for males. CONCLUSION: Regardless of gender, there is the greatest impact of Opera Voice Quality Exercise on phonation intensity. Furthermore, for males, this exercise causes the voice quality to be improved and the speech pitch to raise. Therefore, there may be applications of Opera Voice Quality Exercise in voice problems with weak voice such as nonorganic hypofunctional dysphonia, vocal fold paresis and paralysis, and voice problems related to Parkinson and age.

Phonatory Tasks and Outcome Measures for Assessing Vocal Fatigue: A Scoping Review.

OBJECTIVES: To map the phonatory tasks and the result measures used to evaluate vocal fatigue in vocally healthy individuals. METHODS: This is a scoping review based on the following research question: What are the phonatory tasks and outcome measures used for the evaluation of vocal fatigue in vocally healthy individuals? The construction of the search strategy followed the PCC strategy; population: vocally healthy adult individuals; concept: phonatory tasks and vocal evaluation measures; and context: vocal fatigue. The search was performed electronically in the databases Medline (PubMed), LILACS (BVS), SCOPUS (Elsevier), Web of Science (Clarivate), EMBASE, and COCHRANE. A manual search in the references of the selected articles and in the journal with the highest number of publications was also performed. The selection of articles was based on reading the titles, abstracts, and full text, applying the eligibility criteria. The selected articles were related to the evaluation of vocal fatigue in healthy individuals from a predetermined vocal load task. Data regarding the characteristics of the publication, sample, phonatory tasks, and outcomes were extracted. The results were presented in a descriptive format, due to a frequency distribution analysis. RESULTS: In total, 3756 studies were identified during the search, of which 60 were selected. The most used vocal load activity was the reading task, with duration ranging from 46 to 120 minutes. The (1) sustained vowel /a/ and (2) the reading of texts and phrases, both in usual intensity and frequency without the interference of the researcher, were the most used evaluation tasks. The most used outcome measures are the following: (1) acoustic parameters-fundamental frequency [fo] (mean, variance), sound pressure level (mean), local jitter (%), local shimmer (%), cepstral peak prominence (mean); (2) vocal self-assessment by the validated instruments-Perceived Phonatory Effort Scale, Visual Analog Scale, Borg-CR-10 Scale. CONCLUSIONS: There is a diversity of phonatory tasks and outcome measures recurrently used in scientific articles to evaluate the signs of vocal fatigue in vocally healthy individuals. The most used vocal sample to evaluate vocal fatigue was the sustained vowel /a/ in habitual intensity and frequency without the interference of the researcher. The most frequently reported outcome measures for the assessment of immediate vocal fatigue effects were the acoustic analysis and vocal self-assessment.

Immediate effect of recurrent laryngeal nerve stimulation in patients with idiopathic unilateral vocal fold paralysis.

BACKGROUND: There is a lack of effective treatment for idiopathic unilateral vocal fold paralysis (IUVFP). A better phonation was reported by patients after laryngeal nerve stimulation during our clinical examination. OBJECTIVES: This study aims to investigate immediate effect of recurrent laryngeal nerve (RLN) stimulation on phonation in patients with IUVFP. MATERIAL AND METHODS: Sixty-two patients with clinically identified IUVFP underwent RLN stimulation with needle electrodes. Laryngoscopy, acoustic analysis, and voice perception assessment were performed for quantitative comparison of vocal function and voice quality before and after the intervention. RESULTS: Laryngoscopic images showed a larger motion range of the paralyzed vocal fold (p < .01) and better glottal closure (p < .01) after RLN stimulation. Acoustic analysis revealed that the dysphonia severity index increased significantly (p < .01) while the jitter and shimmer decreased after the intervention (p < .05). According to perceptual evaluation, RLN stimulation significantly increased RBH grades in patients with IUVFP (p < .01). Furthermore, the improvement in voice perception had a moderate positive correlation with the decrease in the glottal closure. CONCLUSIONS AND SIGNIFICANCE: This study shows a short-term improvement of phonation in IUVFP patients after RLN stimulation, which provides proof-of-concept for trialing a controlled delivery of RLN stimulation and assessing durability of any observed responses.

Minimal invasive LASER-resection vs. radiotherapy as primary treatment of early glottic cancer. A population-based study with, up to 16 years follow up of survival, rate of laryngectomy and voice function.

BACKGROUND: Early glottic cancer can be treated with laser resection or radiotherapy. In an earlier study, we found that voice function after laser resection was inferior to that after radiotherapy. OBJECTIVES: This study was designed to determine if reduced margins at laser resection improved voice function without impairing oncologic results. METHOD: A total of 268 patients with previously untreated T1-T2 glottic carcinoma were studied. They were primarily treated with either radiotherapy (n = 119) or laser resection (n = 149). Survival, need for additional treatment (radiotherapy and/or total layngectomi) and voice function was compared. RESULT: Median follow up time was 7 years with range 0.5-16.6. There was no difference in the overall survival (p = .065) or disease-specific survival. (p = .126). After radiotherapy 32/119 patients and after laser resection 57/149 patients had recurrence. Total rate of laryngectomy was 24% in the radiotherapy group, and 8% in the laser resection group (p = .001). Voice analysis (T1A) showed more roughness in the radiotherapy group, otherwise no difference. CONCLUSIONS: By reducing the surgical margins, we have achieved a better voice function (T1A) but more patients have needed repeated laser excisions and some have also needed supplementary radiotherapy. The risk of laryngectomy and survival were apparently not affected.

Reconstruction of Vocal Fold Medial Surface 3D Trajectories: Effects of Neuromuscular Stimulation and Airflow.

INTRODUCTION: Analysis of medial surface dynamics of the vocal folds (VF) is critical to understanding voice production and treatment of voice disorders. We analyzed VF medial surface vibratory dynamics, evaluating the effects of airflow and nerve stimulation using 3D reconstruction and empirical eigenfunctions (EEF). STUDY DESIGN: In vivo canine hemilarynx phonation. METHODS: An in vivo canine hemilarynx was phonated while graded stimulation of the recurrent and superior laryngeal nerves (RLN and SLN) was performed. For each phonatory condition, vibratory cycles were 3D reconstructed from tattooed landmarks on the VF medial surface at low, medium, and high airflows. Parameters describing medial surface trajectory shape were calculated, and underlying patterns were emphasized using EEFs. Fundamental frequency and smoothed cepstral peak prominence (CPPS) were calculated from acoustic data. RESULTS: Convex-hull area of landmark trajectories increased with increasing flow and decreasing nerve activation level. Trajectory shapes observed included circular, ellipsoid, bent, and figure-eight. They were more circular on the superior and anterior VF, and more elliptical and line-like on the inferior and posterior VF. The EEFs capturing synchronal opening and closing (EEF1) and alternating convergent/divergent (EEF2) glottis shapes were mostly unaffected by flow and nerve stimulation levels. CPPS increased with higher airflow except for low RLN activation and very dominant SLN stimulation. CONCLUSION: We analyzed VF vibration as a function of neuromuscular stimulation and airflow levels. Oscillation patterns such as figure-eight and bent trajectories were linked to high nerve activation and flow. Further studies investigating longer sections of 3D reconstructed oscillations are needed. LEVEL OF EVIDENCE: N/A, Basic Science Laryngoscope, 134:1249-1257, 2024.

Effects of Thyroarytenoid Activation Induced Vibratory Asymmetry on Voice Acoustics and Perception.

INTRODUCTION: Asymmetry of vocal fold (VF) vibration is common in patients with voice complaints and also observed in 10% of normophonic individuals. Although thyroarytenoid (TA) muscle activation plays a crucial role in regulating VF vibration, how TA activation asymmetry relates to voice acoustics and perception is unclear. We evaluated the relationship between TA activation asymmetry and the resulting acoustics and perception. METHODS: An in vivo canine model of phonation was used to create symmetric and increasingly asymmetric VF vibratory conditions via graded stimulation of bilateral TA muscles. Naïve listeners (n = 89) rated the perceptual quality of 100 unique voice samples using a visual sort-and-rate task. For each phonatory condition, cepstral peak prominence (CPP), harmonic amplitude (H1-H2), and root-mean-square (RMS) energy of the voice were measured. The relationships between these metrics, vibratory asymmetry, and perceptual ratings were evaluated. RESULTS: Increasing levels of TA asymmetry resulted in declining listener preference. Furthermore, only severely asymmetric audio samples were perceptually distinguishable from symmetric and mildly asymmetric conditions. CPP was negatively correlated with TA asymmetry: voices produced with larger degrees of asymmetry were associated with lower CPP values. Listeners preferred audio samples with higher values of CPP, high RMS energy, and lower H1-H2 (less breathy). CONCLUSION: Listeners are sensitive to changes in voice acoustics related to vibratory asymmetry. Although increasing vibratory asymmetry is correlated with decreased perceptual ratings, mild asymmetries are perceptually tolerated. This study contributes to our understanding of voice production and quality by identifying perceptually salient and clinically meaningful asymmetry. LEVEL OF EVIDENCE: N/A (Basic Science Study) Laryngoscope, 134:1327-1332, 2024.

Comparing dysphonia severity index, objective, subjective, and perceptual analysis of voice in patients with multiple sclerosis and healthy controls.

BACKGROUND: Impairments in voice quality in Multiple Sclerosis (MS) have recently been investigated and different results were found. A voice-centered multidimensional assessment protocol with patient-reported outcome measures was conducted to evaluate all the aspects of the voice changes. OBJECTIVES: The study aimed to compare the objective, subjective, and perceptual measures of voice between the people with MS and the healthy control group. METHODS: A total of 128 participants, including 64 people with MS age, and gender-matched healthy controls were enrolled in the study. Subjective, objective, and auditory-perceptual voice assessments of the participants were performed. The auditory-perceptual evaluation was performed with GRBAS. The Dysphonia Severity index was computed for both groups. All the participants completed the Turkish version of The Voice Handicap Index-10 (VHI-10) and the Voice-Related Quality of Life (VRQoL). RESULTS: Acoustic and aerodynamic parameters of voice were found significantly different for both males and females between the MS and control group. DSI was found significantly different for both males and females in the MS group compared to the control group (p<0.05). All components of the GRBAS scale were significantly higher in the MS group (p<0.001). Using a multivariate regression model, it was determined that age, gender, EDSS score, number of MS attacks, and disease duration did not affect the DSI. The overall VHI-10 score was higher in the MS group (median=1.0 range= 0-28) and lower in the control group (median=0 range= 0-4). The mean VRQoL was lower in the MS group (median=95 range= 62.5-100) than in controls (median=100 range= 85-100) (p<0.001). CONCLUSION: Our results indicated that people with MS have significant differences in acoustic and aerodynamic parameters of voice compared to healthy individuals. A significant number of persons with MS are aware that their voice problem affects their quality of life. People with MS must be monitored for voice changes and a multidimensional voice assessment protocol should be implemented.

Evidência de validade baseada nos processos de resposta de um protocolo de análise espectrográfica da voz / Evidence of response process validity of a spectrographic voice analysis protocol

RESUMO Objetivo desenvolver a etapa de validade baseada nos processos de resposta do Protocolo de Análise Espectrográfica da Voz (PAEV). Métodos foram recrutados dez fonoaudiólogos e dez alunos de graduação em Fonoaudiologia, que aplicaram o PAEV em dez espectrogramas, realizaram o julgamento dos itens do PAEV e participaram de uma entrevista cognitiva. A partir das respostas, o PAEV foi reanalisado para reformulação ou para exclusão de itens. Utilizou-se o teste Qui-Quadrado e os valores de acurácia para análise das respostas dos questionários, assim como análise qualitativa dos dados da entrevista cognitiva. Resultados os participantes obtiveram acurácia maior que 70% na maioria dos itens do PAE. Apenas sete itens alcançaram acurácia menor ou igual a 70%. Houve diferença entre as respostas de presença versus ausência de dificuldade na identificação dos itens no espectrograma. A maioria dos participantes não teve dificuldade na identificação dos itens do PAEV. Na entrevista cognitiva, apenas seis itens não obtiveram correta identificação da intenção, conforme verificado na análise qualitativa. Além disso, os participantes sugeriram exclusão de cinco itens. Conclusão após a etapa de validação baseada nos processos de resposta, o PAEV foi reformulado. Sete itens foram excluídos e dois itens foram reformulados. Dessa forma, a versão final do PAEV após essa etapa foi reduzida de 25 para 18 itens, distribuídos nos cinco domínios.

ABSTRACT Purpose To develop the validity step based on the response processes of the Spectrographic Analysis Protocol (SAP). Methods 10 speech therapists and 10 undergraduate students of the Speech Therapy course were recruited, who applied the SAP in 10 spectrograms, performed the evaluation of the PAE items, and participated in a cognitive interview (CI). The SAP was reanalyzed to reformulate or exclude items based on the responses. The chi-square test and the accuracy values were used to analyze the answers to the questionnaires and qualitative analysis of the CI data. Results the participants achieved accuracy > 70% in most items of the SAP. Only seven items achieved accuracy ≤ 70%. There was a difference between presence vs. absence of difficulty in identifying items in the spectrogram. Most participants had no problem identifying the SAP items. In the CI, only six items did not correctly identify the intention, verified in the qualitative analysis. In addition, participants suggested excluding five items. Conclusion After the validation step based on the response processes, the SAP is reformulated. Seven items were deleted, and two items were reformulated. Thus, the final version of the SAP after this stage was reduced from 25 to 18 items, distributed in the five domains.

Análisis cepstral de la voz normal y patológica en español colombiano mediante el uso del programa PRAAT / Cepstral analysis of normal and pathological voice in Colombian Spanish using the PRAAT program

Introducción: las medidas auditivo-perceptuales subjetivas GRABS (Grade [grado de gravedad], Roughness [aspereza], Asthenia [astenia], Breathiness [soplosidad] y Strain [tensión] y CAPE-V (Consensus Auditory-Perceptual Evaluation of Voice) han sido el estándar de oro en evaluar la voz. La prominencia del pico cepstral suavizado (CPPS) se impone como la medida acústica objetiva más robusta para evaluar la gravedad de la disfonía. Se evaluó el análisis cepstral del programa PRAAT en pacientes con voz patológica y no patológica en hablantes de español colombiano y los valores estándar para el CPPS en lenguaje conectado (CPPSc), comparado con el análisis perceptual de la voz (GRBAS). Métodos: estudio observacional y analítico de prueba diagnóstica, de corte transversal y multicéntrico, con 120 individuos. Se grabó la voz y se analizó el CPPSc con el programa PRAAT. Se aplicó la valoración auditiva-perceptual por dos evaluadores expertos para la escala GRBAS. Resultados: el promedio de edad fue 43,3 años, 64,2 % mujeres. La media del CPPSc en el grupo disfónico fue de 6,40 dB y en el grupo de normofónicos fue 8,54 dB con p=0,000. Sensibilidad de 83,6% y especificidad de 96,2 % para la voz patológica en los pacientes con valores de CPPSc menores a 7,38 dB. Hubo alta correlación del valor de CPPSc con la gravedad de la disfonía. Conclusiones: el valor del CPPSc mediante el programa PRAAT es una medida eficiente por su alta validez, bajo costo y fácil aplicación para evaluar objetivamente la disfonía y su gravedad.

Introduction: Subjective auditory-perceptual measurements, GRABS (Grade, Roughness, Asthenia, Breathiness y Strain) and CAPE-V (Consensus Auditory Perceptual Evaluation of Voice) have been the gold standard in voice evaluation. Recently, the smoothed cepstral peak prominence (CPPS) has been imposed as the acoustic measurement, objective and more robust for dysphonia severity. Objectives: The cepstral analysis of the PRAAT program was evaluated in patients with a patho-logical and non-pathological voice in Colombian Spanish speakers and the standard values for the CPPS in connected language (CPPSc), compared with the perceptual analysis of the voice (GRBAS). Methods: An observational, analytical, cross-sec-tional, multicenter diagnostic test was performed with 120 individuals. The voice was recorded and the CPPSc was analyzed with the PRAAT program. The auditory-perceptual assessment was applied by two expert evaluators for the GRBAS scale. Results: The average age was 43.3 ± 18.1 years, 64.2% were women. The mean CPPSc in the dysphonic group was 6.40 dB, while in the group of normophonic indi-viduals it was 8.54 dB, with significant differences between both groups (p=0.000). Sensitivity of 83.6% and specificity of 96.2%; for pathological voice was established in patients with CPPSc values less than 7.38 dB. A high correlation was found in the CPPSc value with the severity of dysphonia. Conclusions: The value of CPPSc through the Praat program is an efficient measure, due to its high validity, low cost and easy application to objectively evaluate dysphonia and its severity.

Medidas espectrais e cepstrais em mulheres com disfonia comportamental / Spectral and cepstral measurements in women with behavioral dysphonia

RESUMO Objetivo Investigar se existem diferenças nas medidas acústicas cepstrais e espectrais entre mulheres com disfonia comportamental com e sem lesão laríngea, bem como verificar se existe correlação entre tais medidas e o julgamento perceptivo-auditivo da qualidade vocal. Método Participaram 78 mulheres com disfonia comportamental sem lesão laríngea (DCSL) e 68 com disfonia comportamental com lesão laríngea (nódulos vocais) (DCCL). Foram extraídas as medidas CPP (cepstral peak prominence), CPPS (cepstral peak prominence smoothed), declínio espectral e H1-H2 (diferença entre a amplitude do primeiro e do segundo harmônico), assim como o julgamento perceptivo-auditivo (JPA) do grau geral de desvio vocal (GG), graus de rugosidade (GR), de soprosidade (GS) e de tensão (GT). Resultados Mulheres com DCCL apresentaram maiores valores de H1-H2 e menores valores no CPP e CPPS, em relação às mulheres com DCSL. As vozes mais desviadas apresentaram menores valores do CPP e CPPS. As vozes soprosas apresentaram menores valores de CPP e CPPS, assim como maior valor de H1-H2 em relação às vozes rugosas. Houve correlação negativa fraca entre o CPP e o GR, negativa moderada com o GG e negativa forte com o GS. O CPPS apresentou correlação negativa moderada com o GG, GR e GS. A medida H1-H2 apresentou correlação positiva fraca com o GS. Houve correlação positiva fraca entre o declínio espectral e o GT. Conclusão As medidas acústicas H1-H2, CPP e CPPS apresentam diferenças entre mulheres com DCSL e DCCL. Além disso, há correlação entre as medidas cepstrais e espectrais e os diferentes parâmetros do JPA.

ABSTRACT Purpose To investigate whether there are differences in cepstral and spectral acoustic measures between women with behavioral dysphonia with and without laryngeal lesions and verify whether there is a correlation between such measures and the auditory-perceptual evaluation of voice quality. Methods The sample comprised 78 women with behavioral dysphonia without laryngeal lesions (BDWOL) and 68 with behavioral dysphonia with laryngeal lesions (vocal nodules) (BDWL). Cepstral peak prominence (CPP), cepstral peak prominence-smoothed (CPPS), spectral decrease, and H1-H2 (difference between the amplitude of the first and second harmonics) were extracted. They were submitted to the auditory-perceptual evaluation (APE) of the grade of hoarseness (GH), roughness (RO), breathiness (BR), and strain (ST). Results BDWL women had higher H1-H2 values and lower CPP and CPPS values than BDWOL women. More deviant voices had lower CPP and CPPS values. Breathy voices had lower CPP and CPPS values and higher H1-H2 values than rough ones. There was a weak negative correlation between CPP and RO, a moderate negative correlation with GH, and a strong negative correlation with BR. CPPS had a moderate negative correlation with GH, RO, and BR. H1-H2 had a weak positive correlation with BR. There was a weak positive correlation between spectral decrease and ST. Conclusion H1-H2, CPP, and CPPS were different between BDWOL and BDWL women. Furthermore, cepstral and spectral measures were correlated with the different APE parameters.

Clinical Utility and Validation of the Acoustic Voice Quality and Acoustic Breathiness Indexes for Voice Disorder Assessment in English Speakers.

BACKGROUND: While several acoustic voice metrics are available for clinical voice assessment, there remains a significant need for reliable and ecologically valid tools. The Acoustic Voice Quality Index version 03.01 (AVQI-3) and Acoustic Breathiness Index (ABI) hold potential due to their comprehensive assessment approach, incorporating diverse voice aspects. However, these tools still need to be validated in English-speaking populations. METHODS: This study assessed the discriminatory accuracy and validity of AVQI-3 and ABI in 197 participants, including 148 with voice disorders. Voice samples were collected, followed by AVQI-3 and ABI calculations. Additionally, auditory-perceptual assessments were conducted by a panel of speech-language pathologists. RESULTS: AVQI-3 and ABI effectively identified disordered voice quality, evidenced by high accuracy (AUCs: 0.84, 0.89), sensitivity, and specificity (thresholds: AVQI-3 = 1.17, ABI = 2.35). Strong positive correlations were observed with subjective voice quality assessments (rs = 0.72, rs = 0.77, p < 0.001). CONCLUSIONS: The study highlights AVQI-3 and ABI as promising instruments for clinically assessing voice disorders in U.S. English speakers, underscoring their utility in clinical practice and voice research.

The impact of a speaker's voice quality on auditory perception and cognition: a behavioral and subjective approach.

Introduction: Our voice is key for conveying information and knowledge to others during verbal communication. However, those who heavily depend on their voice, such as teachers and university professors, often develop voice problems, signaled by hoarseness. The aim of this study was to investigate the effect of hoarseness on listeners' memory for auditory-verbal information, listening effort, and listening impression. Methods: Forty-eight normally hearing adults performed two memory tasks that were auditorily presented in varied voice quality (typical vs. hoarse). The tasks were Heard Text Recall, as part of a dual-task paradigm, and auditory Verbal Serial Recall (aVSR). Participants also completed a listening impression questionnaire for both voice qualities. Behavioral measures of memory for auditory-verbal information and listening effort were performance and response time. Subjective measures of listening effort and other aspects of listening impression were questionnaire rating scores. Results: Results showed that, except for the aVSR, behavioral outcomes did not vary with the speaker's voice quality. Regarding the aVSR, we found a significant interaction between voice quality and trial, indicating that participants' recall performance dropped in the beginning of the task in the hoarse-voice condition but not in the typical-voice condition, and then increased again toward the end. Results from the listening impression questionnaire showed that listening to the hoarse voice resulted in significantly increased perceived listening effort, greater annoyance and poorer self-reported performance. Discussion: These findings suggest that hoarseness can, at least subjectively, compromise effective listening. Vocal health may be particularly important in the educational context, where listening and learning are closely linked.

Normative Values for the Spanish Version of the Voice Symptom Scale (VoiSS)

Objective: The aim of this study was to establish normative values for the Voice Symptom Scale (VoiSS) in the Spanish community population (without voice problems), using a sample from a large area of southeastern Spain. Method: The sample consisted of 115 adults from ages 16 to 87, 60 of whom were women and 55 were men. Participants included the family members of patients who attended the Otorhinolaryngology (ENT) and Speech Therapy Clinic at a referral hospital in the region of Murcia, Spain, and some of the clinic's staff. All the participants reported never having suffered from any voice disorder before. Results: The normative values obtained in this study for the VoiSS were 14.61 (SD=8.18) for the total score, 7.57 (SD = 5.42) for the Impairment subscale, 1.04 (SD = 1.65) for the Emotional subscale, and 5.99 (SD = 3.61) for the Physical subscale. The percentile values were also obtained for the VoiSS scale and for its three subscales. Conclusions: This study presents normative values for the VoiSS scale that have not previously been obtained in Spain. These values can be used as a reference to detect possible voice disorders.

Objetivo: El objetivo de este estudio fue establecer valores normativos para la escala Voice Symptom Scale (VoiSS) en población comunitaria española (sin problemas de voz), utilizando una muestra de un área extensa del sureste de España. Metodología: La muestra estuvo compuesta por 115 personas (60 mujeres y 55 hombres) con edades comprendidas entre los 16 y 87 años. Los participantes eran familiares que acompañaron a los pacientes a las sesiones clínicas de ORL y de Logopedia de un hospital de referencia de la Región de Murcia, así como personal del hospital. Todos declararon no padecer ningún trastorno de la voz. Resultados: Los valores normativos obtenidos en este estudio para el VoiSS fueron 14.61 (SD=8.18) para la puntuación total, 7.57 (SD = 5.42) para la subescala Limitación, 1.04 (SD = 1.65) para la subescala Emocional y 5.99 (SD = 3.61) para la subescala Física. Los valores percentílicos se obtuvieron también para la escala VoiSS y para sus tres subescalas. Conclusiones: Este estudio presenta valores normativos para la escala VoiSS que no han sido todavía obtenidos en España. Estos valores pueden utilizarse como referencia para detectar posibles trastornos de voz.

Self-Reported Voice-Related Quality of Life in Cochlear Implant Users

Objective: The aim of this study was to identify if cochlear implant (CI) users are perceiving a decrease in life quality due to voice problems. This study evaluated 43 CI user's perception of their voice and how it affects their quality of life through a survey. Approach: Forty-three CI users responded to a survey regarding their demographics, details about their CI, the Hearing Health Quick Test (HHQT), the Voice Related Quality of Life (V-RQOL), and the Voice Handicap Index-10 (VHI-10). The survey responses were analyzed using univariate linear regression analysis. Results: Few of the CI users scored below the cut off for normal voice related quality of life. CI users averaged 93.4 out of 100 on the V-RQOL and only four scored abnormally for the VHI-10. Lower scores on the V-RQOL were correlated with the participants having an associate degree and with participants visiting friends, family, and neighbors less often due to hearing loss. The VHI-10 scores were correlated with gender, education levels, difficulty in social situations due to hearing loss, noise exposure, and tinnitus. Limitations of the study: The small n was the primary limitation of this study. Originality: This study was one of the first to examine the voice-related quality of life in CI users. Conclusions: Overall, respondents did not perceive much voice-related difficulty. However, they were more likely to perceive voice-related difficulty if they experienced difficulty hearing in noise and avoided social situations due to hearing loss.

Objetivo: Este estudio identificó si los usuarios de implantes cocleares (IC) están percibiendo una disminución en la calidad de su vida debido a problemas de voz. Además, evaluó la percepción de la voz de 43 usuarios de IC y cómo afecta su calidad de vida a través de una encuesta. Enfoque: Cuarenta y tres usuarios de IC respondieron a una encuesta sobre su demografía, detalles sobre su IC, la Hearing Health Quick Test (HHQT), la Voice Related Quality of Life (V-RQOL) y el Voice Handicap Index-10 (VHI-10). Las respuestas de la encuesta se analizaron mediante un análisis de regresión lineal univariado. Resultados: Pocos usuarios de IC puntuaron por debajo del límite para calidad de vida relacionada con la voz. El promedio V-RQOL fue de 93,4/100; solo 4 participantes tuvieron puntuación anormal en VHI-10. Las bajas puntuaciones en V-RQOL se correlacionaron con título de asociado y menos visitas por pérdida auditiva; las puntuaciones VHI-10, con sexo, educación, dificultad en situaciones sociales, exposición al ruido y tinnitus. Limitaciones del estudio: La pequeña n fue la principal limitación de este estudio. Originalidad: Este estudio fue uno de los primeros en examinar la calidad de vida relacionada con la voz en usuarios de CI. Conclusiones: En general, los encuestados no percibieron mucha dificultad relacionada con la voz. Sin embargo, era más probable que percibieran dificultades relacionadas con la voz si tenían dificultades para oír en ruido y evitaban situaciones sociales debido a la pérdida auditiva.

Risk of Dysphonia in Legal Professionals: Proposal for a Screening Protocol

Introduction: Due to the communicative requirements inherent to the profession, the legal professional benefits from speech therapy monitoring for the proper use of the voice and to avoid the occurrence of vocal disorders. The development of specific instruments will contribute with more relevant data to guide this monitoring. Objective: To verify the applicability of the General Dysphonia Risk Screening Protocol (DRSP-G) and the Specific Dysphonia Risk Screening Protocol for Legal Professionals (DRSP-LP) and to correlate the average scores of both with vocal deviation, sex, age, professional performance time, vocal signs and symptoms, and vocal self-assessment. Methods: Fifty legal professionals participated. All participants completed the DRSP-G and DRSP-LP and recorded their voices for detection of the presence of altered vocal quality. Results: Most participants presented a high risk of dysphonia, which was higher in men. Altered vocal quality was observed in 34% of the participants. The items with the highest scores in the DRSP-G were talking a lot (76%), excessive daily coffee intake (70%), contact with smokers (60%), and insufficient hydration and sleep (48%); in the DRSP-LP, alcohol consumption (68%) and exposure to air conditioning (64%). There was no correlation between risk scores and the degree of dysphonia, or with age or length of professional experience. The DRSP-G score correlated with vocal signs and symptoms and vocal self-perception. Conclusions: The joint application of the DRSP-G and the DRSP-LP enabled a quantitative and qualitative analysis of risk factors for dysphonia in legal professionals.

Introducción: Debido a las exigencias comunicativas inherentes a la profesión, el profesional del derecho se beneficia del seguimiento logopédico para el correcto uso de la voz y para evitar la aparición de trastornos vocales. El desarrollo de instrumentos específicos contribuirá con datos más relevantes para guiar este seguimiento. Objetivo: Verificar la aplicabilidad del Protocolo General de Detección de Riesgo de Disfonía (DRSP-G) y el Protocolo de Detección de Riesgo Específico para Profesionales del Derecho (DRSP-LP) y correlacionar las puntuaciones de ambos con varias variables de interés. Metodología: Participaron 50 profesionales del derecho. Todos completaron el DRSP-G y DRSP-LP y grabaron sus voces para detectar la presencia de alteraciones en la calidad de la voz. Resultados: La mayoría presentó un alto riesgo de disfonía, que fue mayor en los hombres. Se observó alteración en la calidad de la voz en el 34% de los participantes. Los ítems con puntajes más altos en el DRSP-G fueron hablar mucho (76%), ingesta diaria excesiva de café (70%), contacto con fumadores (60%) e hidratación y sueño insuficientes (48%); y en el DRSP-LP, consumo de alcohol (68%) y exposición al aire acondicionado (64%). No hubo correlación entre las puntuaciones de riesgo y el grado de disfonía, ni con la edad o la antigüedad profesional. La puntuación DRSP-G se correlacionó con los signos y síntomas vocales y la autopercepción vocal. Conclusiones: La aplicación conjunta del DRSP-G y el DRSP-LP permitió un análisis cuantitativo y cualitativo de los factores de riesgo de disfonía en profesionales del derecho.

The Minimal Important Difference of Acoustic Voice Quality Index in the Treatment of Voice Disorders.

OBJECTIVES: The acoustic voice quality index (AVQI) is a reliable tool that objectively assesses dysphonia levels using six acoustic parameters. Despite its high criterion-related concurrent validity, diagnostic accuracy, and minimal detectable change derived from test-retest reliability, the minimal important difference (MID) of the AVQI has not been tested before. This study aimed to estimate the MIDs of AVQI for improvement audibly perceived by clinicians and self-reported improvement by patients. METHODS: A retrospective study was conducted on 110 patients who received treatment for voice disorders. Patients completed AVQI and Voice Handicap Index-10 (VHI-10) questionnaires before and after the therapy. The MIDs of the AVQI were estimated using the anchor of either auditory-perceptual judgment of total dysphonia levels by clinicians or the VHI-10 questionnaire by patients. A distribution-based approach was also used to complement the results. RESULTS: First, using the auditory-perceptual anchor, a decrease of 0.95 in the AVQI was estimated as the MID for clinicians' perception, as a result of the receiver operating curve. Then, using the patient-reported anchor, an improvement of 1.36 in the AVQI was estimated as the MID for patients' voice-related disability. The distribution-based approach also ensured the anchor-based results of both the MIDs. CONCLUSIONS: The AVQI is a reliable and valid tool for evaluating voice quality, and a 0.95 decrease in the AVQI represents a meaningful improvement for clinicians' perception, whereas a 1.36 decrease in the AVQI influences patients' self-reported disability. This study contributes to understanding the minimal change necessary for clinicians to make informed decisions and ensure patient satisfaction. LEVEL OF EVIDENCE: 3 Laryngoscope, 2024.