Comparison of vocal fatigue and vocal tract discomfort between teachers of normal pupils and teachers of mentally disabled pupils.

PURPOSE: This study aims to study the comparison of vocal fatigue and vocal tract discomfort between teachers of normal pupils and teachers of mentally disabled pupils. STUDY DESIGN: Cross-sectional study METHODS: Participants were 179 teachers (50 male, 129 female) and 30 non-teachers (14 male, 16 female) who participated in the current study. The teachers work in elementary schools. Furthermore, 87 of the teachers work for mentally disabled pupils at special elementary schools. Non-teachers were Ahvaz Jundishapur University of Medical Sciences employees who consider as the control group. They completed the Persian VFI and VTDp questionnaires three times, at the beginning, middle, and end of their office hours for 1 workday. RESULTS: The current study's findings indicate that the Persian VFI and VTD scores of non-teachers were significantly lower than teachers' scores. Furthermore, teachers of mentally disabled pupils demonstrated higher values from teachers of normal pupils based on the Persian VFI and VTDp scores CONCLUSION: The study results showed that teachers experienced more vocal fatigue and vocal tract discomfort than non-teachers. Furthermore, teachers of mentally disabled pupils indicated more vocal fatigue, the larynx's physical discomfort, and vocal tract discomfort, but this difference was practically small.

Psychometric properties of the Persian version of the stuttering generalization self-measure tool in adults who stutter.

PURPOSE: Our study aimed to translate the Stuttering Generalization Self-Measure (SGSM) into Persian and investigate its validity, reliability, and internal responsiveness in the Iranian population. METHOD: This study was conducted on 30 adults who stutter (AWS) and 30 adults who do not stutter (AWNS). The International Quality of Life Assessment protocol (IQOLA) was applied to translate SGSM into Persian. The face and content validity were determined. Also, the discriminant validity was evaluated by comparing the scores of two groups. In addition, the internal consistency test-retest, and inter-judge reliability were assessed with Cronbach's alpha and intra-class correlation coefficients (ICC). Moreover, the mean standardized response (MSR) and the standardized effect size were measured to determine the internal responsiveness using pre- and post-treatment data. RESULTS: All the items were comprehensible and clear. The content validity ratio (CVR) and content validity index (CVI) for all nine questions were obtained higher than.62 and.9, respectively. The internal consistency value was high (Cronbach's alpha =.98). For the test-retest reliability, ICC values were excellent, ranging from.93 to.99. The discriminant validity results revealed a significant difference between AWS and AWNS (p < .001). Pre- and post-treatment results indicated high internal responsiveness to changes for percentage of syllable stuttered (SS%) (MSR = 1.09). CONCLUSION: The Persian version of SGSM (P-SGSM) benefits from the high values for validity and reliability. Furthermore, it distinguishes the AWS and AWNS and reflects the treatment changes significantly.

Relationship Between Vocal Fatigue Index and Acoustic Voice Scales in Patients With Coronavirus Infection.

OBJECTIVES: The voice quality of patients with Coronavirus Disease 2019 (COVID-19) seems to be affected due to lower and upper respiratory involvement. Patient-based voice assessment scales are important clinical measures to diagnose voice disorders and monitor treatment outcomes in COVID-19 patients. This study compared vocal fatigue between COVID-19 patients and those with normal voices. Furthermore, the relationship between vocal fatigue and acoustic voice parameters of COVID-19 patients was evaluated. METHODS: This cross-sectional study enrolled 30 laboratory-confirmed patients with COVID-19 (18 males and 12 females) and 30 healthy individuals with normal voices (14 males and 16 females) to compare their respiratory or phonatory parameters. The Persian versions of the Consensus Auditory Perceptual Evaluation of Voice (CAPE-V) and the vocal fatigue index (VFI) were conducted before and after reading the text. The Jitter, shimmer, maximum phonation time, and harmonic-to-noise ratio (HNR) were analyzed by Praat software based on the recorded voices of CAPE-V tasks. The acoustic assessment and VFI questionnaire results were compared between COVID-19 patients and the control group. RESULTS: There were significant differences between COVID-19 patients and their healthy counterparts in all VFI subscales (P < 0.001). Moreover, after reading the text, we found significant differences between the two groups regarding Jitter, shimmer, and HNR of /a/ and /i/ vowels (P < 0.05). Our findings also indicated a significant correlation between symptom improvement with rest and acoustic parameters in all tasks, except the Jitter of /a/ before reading the text. CONCLUSION: Patients with COVID-19 showed significantly more vocal fatigue than people with normal voices after reading the text. Moreover, there was a significant relationship between Jitter, shimmer, and HNR and the tiredness of voice and physical discomfort subscales of VFI.

Relation Between Dysphonia Severity Index (DSI) and Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V).

OBJECTIVES: This study aims to conduct a relationship survey between subjective voice assessment (the Persian version of consensus auditory perceptual evaluation of voice (called ATSHA)) and the Dysphonia Severity index (DSI). STUDY DESIGN: Cross-sectional, methodological study. METHODS: Our sample included 144 adults; 48 patients with different voice disorders and 96 volunteers without voice disorders, hearing complaints or any auditory-perceptual voice disorders. The vocal tasks included in the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) and the DSI were performed and recorded. We used subjective and objective assessments to investigate the correlation between the CAPE-V perceptual-auditory assessment parameters and the DSI. Finally, through using the univariate-linear regression and other statistical analyses, we examined the correlation and prediction value of subjective assessment by the DSI. RESULTS: The result of correlation of the total DSI value and individual items with the CAPE-V parameters demonstrated the strongest correlation between the DSI and breathiness (R = 0/563) in the second sentence of the CAPE-V scale, and the weakest correlation between the DSI and overall severity (R = 0/202) in the sixth sentence. The results of the univariate linear regression model indicated that the highest predictive power was obtained for the DSI and breathiness (R2 = 0/427) in the sixth sentence in the dysphonic group, while the lowest predictive power was found for low intensity and strain (R2 = 0/025) in the connected speech in the control group. CONCLUSION: This study found a significant relationship between the target objective and subjective voice assessment scales in most parameters. Furthermore, the findings of the current study show that the DSI scale, as an objective tool, can predict some auditory-perceptual parameters.

Psychometric Characteristics of Different Versions of Vocal Tract Discomfort (VTD) Scale: A Systematic Review.

BACKGROUND: This review compare different Vocal Tract Discomfort (VTD) versions. This comparison is based on their validity and reliability parameters in the translation and adaptation process. We aimed to prepare numerical evidence to prove the validity of this easy screening tool. VTD is able to perform an accurate diagnosis of voice discomforts, particularly in primary stages. METHODS: Articles were selected from databases including Google Scholar, PubMed, Science Direct and Scopus. Our relevant papers were gathered by searching the phrase: VTD in titles, abstracts, and keys. Studies not followed an adaptive procedure were excluded. Based on the selection criteria, out of 23 collected articles, eight were studied in this review. RESULTS: Standard psychometric protocol steps were followed in all selected articles and simultaneously high reliability and validity were reported in their translation procedure. Such analogous results may confirm the efficacy of this research tool. CONCLUSION: This review affirms VTD, perceptual patient-based scale, as a valuable evaluation tool to investigate the occurrence of voice disorders. Based on its structure and performance, VTD can work as a quick and precise source for predicting vocal discomforts. Moreover, this capability can help professional therapists to plan more efficient treatment procedures. The other important advantage of VTD is its diagnostic and prognostic capacity to inform patients about their current and future conditions so that they would be motivated to follow treatment procedures more consistently.

Construct and Discriminant Validity of the Persian Version of the Consensus Auditory Perceptual Evaluation of Voice (CAPE-V).

PURPOSE: Five dimensions of voice assessment are considered as visual evaluation, videostroboscopy, acoustic, aerodynamic, patient-based, and auditory-perceptual. Auditory-perceptual voice assessment scales are the standard scales for clinicians to document voice therapy outcomes in dysphonic patients. The primary objective of the present study was to investigate the construct and discriminant validities of the Persian Version of the CAPE-V (ATSHA). A secondary objective was to determine the differences between experienced and inexperienced raters in the auditory-perceptual assessment of voice. METHOD: Forty normal and forty individuals with dysphonia were rated by five experienced and five inexperienced raters. Pathological subgroups were vocal fold nodules, vocal fold polyps, unilateral vocal fold paralysis (UVFP), and Reinke's edema. The differences between normal and pathologic groups were observed by independent t tests for all perceptual parameters (P < 0.05). Construct validity was documented for the scale of interest. The Kruskal-Wallis and Mann-Whitney comparisons were used to examine discriminant validity. RESULTS: Findings of these tests showed that scores of all pathological subgroups were significantly different except for the parameter of "strain" in sustained vowels (P < 0.05). Results of the Wilcoxon Matched-Pairs Signed Rank Test indicated that experienced and inexperienced raters were significantly different in auditory-perceptual judgments of voice. CONCLUSION: It seems that the Persian Version of the CAPE-V is a consistent predictor of normal and pathological voices. Moreover, we found that experienced listeners have different auditory-perceptual skills in evaluation of voice that make them more precise than inexperienced listeners.

A Cepstral Peak Prominence (CPP) Voice Analysis in Iranian Post-lingual Deaf Adult Cochlear Implant Users.

OBJECTIVE: In standardized connected speech samples, cepstral peak prominence (CPP) and smoothed CPP (CPPS) have been described as accurate parameters to evaluate voice quality. Lack of normal auditory feedback in post-lingually deaf CI users might influence tuning the acoustic parameters in speech production. Based on shreds of evidence, normal hearing results in suitable vocal control through the sensory-motor linkage. The main aim of the present study was to compare the cepstral values between the Iranian cochlear implant group and normal peers. METHOD: Persian CAPE-V sentences were recorded from 30 CI users and 30 healthy speakers (mean age=36.7 years, SD=13.5, range=18-60 years). Thirteen /a/vowels were extracted manually from syllables. Each subject phonated sustained /a/vowel for 5 seconds. PRAAT was used to calculate CPP and CPPS. To compare two age- and gender-matched groups, the independent sample t-test was applied. Then, ANCOVA was used to assess the impact of demographic factors on cepstral scores in CI participants. RESULTS: Significant differences between the CI group and normal peers were discovered based on CPP and CPPS in both tasks (reading sentences and sustained vowel) (P < 0.05). Overall, CI users showed higher cepstral values. The implanted ear and prosthesis model had no significant impact on both CPP and CPPS (P ≥ 0.8). CONCLUSION: Higher CPP and CPPS values in the CI users might be due to increased phonatory instability and spectral noise, with the possibility of decreased vocal control and its quality. The outcome suggests that CI group uses a different voice control strategy. These findings should be kept in mind for intervention methods, especially by assessing vocal characteristics and considering the voice quality in adult CI users.

Responsiveness of Persian Version of Consensus Auditory Perceptual Evaluation of Voice (CAPE-V), Persian Version of Voice Handicap Index (VHI), and Praat in Vocal Mass Lesions with Muscle Tension Dysphonia.

OBJECTIVES: This study was aimed at determining the internal and external responsiveness of the Persian version of the Consensus Auditory-Perceptual Evaluation of Voice (called ATSHA), Persian version of the Voice Handicap Index (VHI), and Praat scales among patients with vocal mass lesions and secondary muscle tension dysphonia. STUDY DESIGN: Prospective, within-participant repeated measures. METHOD: Thirty patients with vocal fold nodules, polyps, and cysts related to secondary muscle tension dysphonia participated in the study. The measures of interest and videostroboscopy examination were used before and after treatment. The Global Perceived Effect questionnaire was used to separate those improved (moderately or greatly improved) and stable (slightly improved) patients. RESULTS: The mean standardized response, standardized effect size, and Guyatt analyses indicated high internal responsiveness for the all target parameters of the ATSHA, total score of the VHI, and two parameters of the Praat (0.8<). There was poor correlation between the videostroboscopy and the other target scales (r Pearson = -0.1-0.1). The receiver operating characteristic analysis indicated that all the target scales did not significantly separate those improved and stable subjects (area under the curve = 0), except for the overall severity and roughness parameters of the ATSHA scale (area under the curve = 1). CONCLUSION: This study recommends both the Consensus Auditory-Perceptual Evaluation of Voice and the VHI scales to show voice therapy changes. The target voice scale changes were not able to predict the videostroboscopy changes as external standard. Furthermore, we recommend that the overall severity and roughness may properly classify those improved and stable patients.

Patient-Based Assessment of Effectiveness of Voice Therapy in Vocal Mass Lesions with Secondary Muscle Tension Dysphonia.

INTRODUCTION: Use of patient-based voice assessment scales is an appropriate method that is frequently used to demonstrate effectiveness of voice therapy. This study was aimed at determining the effectiveness of voice therapy among patients with secondary muscle tension dysphonia (MTD) and vocal mass lesions. MATERIALS AND METHODS: The study design was prospective, with within-participant repeated measures. Thirty-three patients with secondary MTD and vocal mass lesions participated in the study, selected on the basis of voice history, laryngeal palpation, and videostroboscopy examination. An experienced otolaryngologist and one experienced speech language pathologist undertook the diagnostic process. Voice therapy included both direct and indirect techniques and lasted approximately 2 months for all included patients. The voice handicap index (VHI) was used to evaluate the effectiveness of voice therapy among included patients. Paired t-test, size of the standardized effect (ESI), and mean standardized response (ESII) were used to analyze effectiveness of the target voice therapy. RESULTS: The findings of this study indicate a statistically significant improvement after the voice therapy protocol (P<0.05; t>1.96). Results of ESI and ESII demonstrate that the VHI scale is sufficiently responsive to detect voice therapy change (ES>0.8). CONCLUSION: This study recommends a combination of direct and indirect voice therapy in the vocal rehabilitation of patients with secondary MTD and vocal mass lesions. Furthormore, we recommend use of the VHI scale to show voice therapy changes for both clinical and research purposes.