The Atopy Index Inventory: A Brief and Simple Tool to Identify Atopic Patients.

INTRODUCTION: Atopy and ear, nose and throat (ENT) diseases are frequently associated; however, no clinical tool has been proposed so far to discriminate which patients could be atopic and therefore deserving of a further immunoallergological evaluation. OBJECTIVE: The aim of this study was to assess and validate a set of dichotomous responses suitable for predicting the presence of atopy in adult patients. METHODS: An 11-item questionnaire, i.e., the Atopy Index Inventory (AII), comprised of 4 questions regarding the clinical history for allergic disease and 7 questions evaluating the presence of the most frequent clinical signs affecting allergic patients, was developed and administered to 226 adult subjects (124 atopic subjects and 102 healthy, not atopic subjects). The atopic condition was proven by an immunoallergological evaluation according to the diagnostic criteria of the EAACI guidelines. Internal consistency and clinical validity were tested. RESULTS: In healthy subjects, the first 4 variables of the AII returned a 100% correct response (all answered "no") and were defined as "decisive" responses. In the logistic regression analysis, when decisive items were negative, the atopic condition was confirmed when answering "yes" to at least 3 "probability" items (cut-off = 2.69). The difference in AII scores between allergic and healthy group was significant using the Mann-Whitney U test (p < 0.0001). The sensitivity and specificity of the AII were 0.97 and 0.91, respectively, with a true predictive value of 0.92 and a false predictive value of 0.97. The ROC curve showed an area of 0.94, with an OR of 0.88 (95% CI 0.87-0.97, p = 0.0001). The internal consistency as determined by the Cronbach α coefficient was 0.88. CONCLUSION: The AII has been proven to be a brief, simple and sufficiently accurate tool for screening ENT patients in search of atopic individuals and to allow their clinical management.

Speech Therapy as Treatment for Supragastric Belching.

The purpose of this study was to describe a newly developed speech therapy program as an innovating therapeutic approach and to assess the results of this intervention in patients with supragastric belching. This is a retrospective analysis of prospectively gathered data from 73 patients with supragastric belching who were treated with speech therapy between 2007 and 2017. Of these, 48 were included for evaluation of therapy. Thirty patients had supragastric belching proven by 24-h impedance measurements. Eighteen patients were diagnosed by an experienced speech language pathologist as having supragastric belching according to precise criteria. Speech therapy consists of explanation, creating awareness of esophageal air influx and exercises to discontinue the supragastric belching mechanism. Therapy effect was measured by comparing visual analogue scale (VAS) scores on belching and related symptoms. The median symptom duration at the start of therapy was 2 years. Supragastric belching symptoms decreased significantly with a total median VAS score of 406 (291-463) prior to treatment and a median VAS score of 125 (17-197) following treatment. Forty patients (83%) had a sufficient to major result with a median therapy duration of 3 months and ten sessions. Speech therapy was an effective treatment in the majority of patients with supragastric belching.

A retrospective evaluation of the etiology of unilateral vocal fold paralysis over the last 25 years.

Previous studies have shown that the etiology of laryngeal paralysis has changed over the last decades, with an increase in the incidence of cases attributable to thyroid surgery. The aim of this study was to evaluate longitudinal changes in the etiology of unilateral vocal fold paralysis (UVFP) in a single institution over the last 25 years. This retrospective study analyzed the etiology of UVFP between 1990 and 2015 by comparing a cohort of patients treated in 1990-1992 with a cohort treated in 2013-2015. The final analysis was based on data concerning 356 patients (38.8 % males; mean age 55.3 ± 20.4 years): 113 in the 1990-1992 cohort, and 243 in the 2013-2015 cohort. The main cause of UVFP in the population as a whole was thyroidectomy (41.3 %), followed by an idiopathic origin (25.3 %) and thoracic surgery (12.1 %); this was confirmed in both intra-group analyses. There was a statistically significant association between etiology and the sub-group periods: the prevalence of post-thyroidectomy UVFP was highly significantly lower in the 2013-2015 cohort (35.4 vs 54.0 %), and the prevalence of idiopathic cases was higher (28.4 vs 18.6 %). Etiology significantly related to gender in both cohorts (p value ≤0.001). In the 2013-2015 cohort, there was also a statistically significant relationship between etiology and age classes (p value 0.017), and the left side was more frequently affected than the right (67.1 vs 32.9 %). Our findings document changes in the etiological pattern of UVFP over the last 25 years, with a considerable decrease in post-thyroidectomy UVFP, and a growing predominance of idiopathic and post-thoracic surgery UVFP.

Exploring the sensitivity of speech-in-noise tests for noise-induced hearing loss.

OBJECTIVE: Recently, the digit triplet test was shown to be a sensitive speech-in-noise test for early high-frequency hearing loss in noise-exposed workers. This study investigates if a further improvement is achieved when using a closed set of consonant-vowel-consonant (CVC) speech items with the same vowel, and/or a low-pass (LP) filtered version of the standard speech-shaped noise. DESIGN: Speech reception thresholds in noise were gathered for the digit triplet, CVC, and CVC_LP test and compared to the high-frequency pure-tone average (PTA). STUDY SAMPLE: 118 noise-exposed workers showing a wide range of high-frequency hearing losses. RESULTS: For the 84 Dutch-speaking participants, the CVC test showed an increased measurement error and a decreased between-subject variation, leading to a weaker correlation with the PTA2,3,4,6 (R = 0.64) and thus a lower sensitivity compared to the digit triplet test (R = 0.86). However, the use of LP-filtered noise resulted in a sensitivity improvement (R = 0.79 versus R = 0.64) due to the large increase in between-subject spread. Similar trends were found for the 34 French-speaking workers. CONCLUSIONS: Using CVC words with the same vowel could not increase the sensitivity to detect isolated high-frequency hearing loss. With LP-filtered noise, test sensitivity improved, but it did not surpass the original digit triplet test.

Efficient hearing screening in noise-exposed listeners using the digit triplet test.

OBJECTIVES: Hearing screening in occupational medicine is generally based on pure-tone threshold audiometry. However, reliable and valid thresholds can only be obtained in a sound-proof room, using a high-quality, well-calibrated audiometer, and by a well-trained administrator. Thresholds also need to be determined for several audiometric frequencies. This makes the test time-consuming and expensive, which is not ideal for the screening of large populations. A Speech-In-Noise test (SPIN), by contrast, does not have the abovementioned requirements. Because it can be implemented as a quick automated self-test, possibly over the Internet, a SPIN test is highly advantageous for screening purposes. However, its sensitivity for (isolated) high-frequency hearing loss, as typically seen in noise-exposed listeners, was unclear up to present. In this study, the authors investigated the sensitivity and specificity of the Digit Triplet SPIN test for detecting and monitoring (early-stage) high-frequency hearing loss, and its similarity across two different language versions. DESIGN: One-hundred eighteen noise-exposed workers, representing a wide range from no to severe high-frequency hearing loss, completed the French or Dutch version of the broadband Digit Triplet self-test in an office-like room. Pure-tone thresholds, collected by a professional audiologist in favorable settings, served as the reference. RESULTS: The 84 Dutch-speaking participants showed a very strong linear relation between the reference and the Digit Triplet test, with the pure-tone average at 2, 3, 4, and 6 kHz as a strong predictor (R = 0.86) for the speech-reception threshold. The sensitivity and specificity to detect mild high-frequency hearing loss were 92% (61 of 66) and 89% (16 of 18), respectively. The area under the receiver operating characteristic (ROC) curve was very high (≥0.91) for several degrees of high-frequency hearing loss. With a within-subject standard deviation of only 0.8 dB, the Digit Triplet test also had a low measurement error. The results of the 34 French-speaking subjects showed a highly similar trend. CONCLUSIONS: The Digit Triplet test proves to have a high sensitivity and specificity for detecting different degrees of high-frequency hearing loss. Given its ease of use, this test is very suitable for screening purposes in occupational medicine, and potentially for the screening of adolescents at risk of recreational noise-induced hearing loss.

Asymmetry of Occupational Noise Induced Hearing Loss: An Electrophysiological Approach.

Introduction The question as to whether occupational noise exposure causes symmetrical or asymmetrical hearing loss is still controversial and incompletely understood. Objective Two electrophysiological methods (cortical evoked response audiometry: CERA and auditory steady state responses: ASSR) were used to address this issue. Method 156 subjects with a well-documented history of noise exposure, a wide range of noise induced hearing loss (NIHL) and without middle ear pathology underwent both a CERA and an ASSR examination in the context of an exhaustive medicolegal expert assessment intended for possible compensation. Results Whatever the method (CERA or ASSR), the average electrophysiological hearing thresholds (1-2-3 kHz) are significantly worse in the left ear. The right - left differences in CERA and ASSR thresholds are strongly correlated with each other. No significant effect of frequency is found. No correlation is observed between right - left differences in hearing thresholds and either age or degree of hearing loss. Conclusion In NIHL, there is an actual average right - left difference of about 2.23 dB, i.e., 3.2%, the left ear being more impaired.

Machine Learning Assessment of Spasmodic Dysphonia Based on Acoustical and Perceptual Parameters.

Adductor spasmodic dysphonia is a type of adult-onset focal dystonia characterized by involuntary spasms of laryngeal muscles. This paper applied machine learning techniques for the severity assessment of spasmodic dysphonia. To this aim, 7 perceptual indices and 48 acoustical parameters were estimated from the Italian word /a'jwɔle/ emitted by 28 female patients, manually segmented from a standardized sentence and used as features in two classification experiments. Subjects were divided into three severity classes (mild, moderate, severe) on the basis of the G (grade) score of the GRB scale. The first aim was that of finding relationships between perceptual and objective measures with the Local Interpretable Model-Agnostic Explanations method. Then, the development of a diagnostic tool for adductor spasmodic dysphonia severity assessment was investigated. Reliable relationships between G; R (Roughness); B (Breathiness); Spasmodicity; and the acoustical parameters: voiced percentage, F2 median, and F1 median were found. After data scaling, Bayesian hyperparameter optimization, and leave-one-out cross-validation, a k-nearest neighbors model provided 89% accuracy in distinguishing patients among the three severity classes. The proposed methods highlighted the best acoustical parameters that could be used jointly with GRB indices to support the perceptual evaluation of spasmodic dysphonia and provide a tool to help severity assessment of spasmodic dysphonia.

Vocal Fold Collision Speed in vivo: The Effect of Loudness.

Mechanical impact stress on the vocal fold surface, particularly when excessive, has been postulated to cause the so-called phonotraumatic tissue lesions, such as nodules and polyps. The collision stress between the vocal folds depends on the vocal fold velocity at the time of impact. Hence this vocal fold collision speed is a relevant parameter when considering biomechanical economy of phonation, especially in voice professionals needing a louder voice than normal. Combining a precise photometric measurement of glottal area and simultaneous measurements of translaryngeal impedance (electroglottogram) for identifying the time of the maximum rate of increase of vocal fold contact allows computing the vocal fold collision speed in a wide range of loudnesses. The vocal fold collision speed is - for modal voicing - always smaller than the maximum vocal fold velocity during the closing phase, but it strongly increases with intensity. Moreover, this increase shows a biphasic pattern, with a significant enhancement from a certain value of dB on. Understanding physiological variables that influence vocal fold collision forces provides relevant insight into the pathophysiology and the prevention of voice disorders associated with phonotraumatic vocal hyperfunction.

Semioccluded Vocal Tract Exercises Improve Self-Perceived Voice Quality in Healthy Actors.

PURPOSE: Semi-occluded vocal tract exercises (SOVTE) have shown to lead to more effective and efficient vocal production for individuals with voice disorders and for singers. The aim of the present study is to investigate the effects of a 10-minute SOVTE warm-up protocol on the actors' voice. METHODS: Twenty-seven professional theater actors (16 females) without voice complaints were audio-recorded while reading aloud, with their acting voice, a short dramatic passage at four time points. Recordings were made: the day before the show, just before and soon after the warm-up protocol which was performed prior to the show and soon after the show. The voice quality was acoustically and auditory-perceptually evaluated and quantified at each time point by blinded raters. Self-assessment parameters anonymously collected pre and post exercising were also analyzed. RESULTS: No statistically significant differences on perceptual ratings and acoustic parameters were found between pre/post exercise sessions and males/females. A statistically significant improvement was detected in the self-assessment parameters concerning comfort of production, sonorousness, vocal clarity and power. CONCLUSIONS: Vocal warm-up with the described SOVTE protocol was effective in determining a self-perceived improvement in comfort of production, voice quality and power, although objective evidence was missing. This straightforward protocol could thus be beneficial if routinely utilized by professional actors to facilitate the voice performance.

Intraglottal Aerodynamics at Vocal Fold Vibration Onset.

The most frequently observed type of voice onset in spontaneous speech in normal subjects is the soft onset, and it may be considered as the "physiological" onset. It starts from an immobile narrow glottal slit crossed by a continuous airflow, and then a few oscillations (even a single one in some cases) precede the first glottal closure. It is a transient event, during which the acting forces, lung pressure, intraglottal pressure, myoelastic tension of the vocal fold (VF) oscillator and inertance of the supraglottal vocal tract, interact to progressively reach the steady state of a sustained oscillation. Combined measurements of flow, area, and pressure provide a detailed qualitative and quantitative analysis of the intraglottal mechanical events at the precise moment of starting oscillation in a physiological (soft or soft/breathy) onset. Our in vivo measurements of airflow and glottal area show that the very first oscillation occurs exactly at the time when turbulence appears at the level of the glottal narrowing, ie, when the Reynolds number reaches its critical value. The turbulence may be assumed to trigger an oscillator consisting in the ensemble of the VFs and the air of the vocal tract, which is known to be weakly damped. Turbulence can act here as an aspecific flick, triggering the oscillator, the frequency of oscillation being determined by its mechanical properties. Furthermore, the first noticeable glottal oscillations are sinusoidal: the VFs are neither steeply sucked together by a negative Bernoulli pressure, nor burst apart by the lung pressure. Our measurements show that, at the critical time, the rising positive lung pressure is balanced by the rising negative Bernoulli pressure generated by the transglottal flow.

In Vivo Quantification of the Intraglottal Pressure: Modal Phonation and Voice Onset.

Intraglottal pressure is the driving force of vocal fold vibration. Its time course during the open phase of the vibratory cycle is essential in the mechanics of phonation, but measuring it directly is difficult and may hinder spontaneous voicing. However, it can be computed from the in vivo measured transglottal flow and glottal area (hence the air particle velocity) on the basis of the Bernoulli energy law and the interaction with the inertance of the vocal tract. As to sustained modal phonation, calculations are presented for the two possible shapes of glottal duct: convergent and divergent, including absolute calibration in order to obtain quantitative physical values. Whatever the glottal duct configuration, the calculations based on measured values of glottal area and air flow show that the integrated intraglottal pressure during the opening phase systematically exceeds that during the closing phase, which is the basic condition for sustaining vocal fold oscillation. The key point is that the airflow curve is skewed to the right relative to the glottal area curve. The skewing results from air compressibility and vocal tract inertance. The intraglottal pressure becomes negative during the closing phase. As to the soft (or physiological) voice onset, a similar approach shows that the integrated pressure differences (opening phase - closing phase) actually increase as the onset progresses, and this applies to the results based on Bernoulli's energy law as well as to those based on the interaction with the inertance of the vocal tract. Furthermore and similarly, the phase lead of the pressure wave with respect to the glottal opening progressively increases. The underlying explanation lies in the progressively increasing skewing of the airflow curve to the right with respect to the glottal area curve.

Language development before and after temporal surgery in children with intractable epilepsy.

PURPOSE: To obtain systematic knowledge of language development before and after epilepsy surgery in regions that, if damaged, are known to entail language impairment in adults. METHODS: Twenty-four children (mean age 11 years; range 5.8-15.7 years) with pharmacologically intractable epilepsy participated prior to (the majority) anterior temporal lobectomy and 6, 12, and 24 months thereafter. Reception and production of lexicon (vocabulary) and syntax (sentence structure including grammar) were examined using developmental language tests that provide normative data. RESULTS: Prior to surgery the mean language delay varied from 1.7 years (productive syntax) to 3.5 years (productive lexicon). For lexicon, language delay was larger, the older the children; for syntax it was smaller in children with mothers with higher education. Over the 2 years following surgery, the children developed in all four language components. Development was, however, slower than normal, that is, language delay increased, in three of the four components: in productive lexicon it continued to increase, and in receptive lexicon and productive syntax it appeared to stabilize during the second year. Receptive syntax developed at a normal pace. The development of productive lexicon was remarkably slow when surgery and language mediation were both in the left hemisphere. DISCUSSION: Pharmacologically intractable epilepsy of the temporal lobe, or the underlying condition, is a significant risk factor for delayed language development. Temporal epilepsy surgery does not result in acceleration of language development. If language is still mediated in the operated left hemisphere, development of particular language components may slow down after surgery.

Spasmodic dysphonia, perceptual and acoustic analysis: presenting new diagnostic tools.

In this article, we investigate whether (1) the IINFVo (Impression, Intelligibility, Noise, Fluency and Voicing) perceptual rating scale and (2) the AMPEX (Auditory Model Based Pitch Extractor) acoustical analysis are suitable for evaluating adductor spasmodic dysphonia (AdSD). Voice recordings of 12 patients were analysed. The inter-rater and intra-rater consistency showed highly significant correlations for the IINFVo rating scale, with the exception of the parameter Noise. AMPEX reliably analyses vowels (correlation between PUVF (percentage of frames with unreliable F0/voicing 0.748), running speech (correlation between PVF (percentage of voiced frames)/voicing 0.699) and syllables. Correlations between IINFVo and AMPEX range from 0.608 to 0.818, except for noise. This study indicates that IINFVo and AMPEX could be robust and complementary assessment tools for the evaluation of AdSD. Both the tools provide us with the valuable information about voice quality, stability of F0 (fundamental frequency) and specific dimensions controlling the transitions between voiced and unvoiced segments.

Pathogenesis of vocal fold nodules: new insights from a modelling approach.

OBJECTIVE: To give new insights into the pathogenesis of vocal fold nodules: (a) why the female/male ratio is so extreme, (b) how an hourglass-shaped vibration pattern - eliciting a localized microtrauma - originates, and (c) what the roles of muscular tension imbalance and of behavioral aspects are. MATERIALS AND METHODS: Simulations with a 3-dimensional computer model of the vibrating vocal folds. RESULTS AND CONCLUSION: (1) A slightly incomplete dorsal vocal fold adduction is a first condition for inducing an hourglass vibration pattern. (2) A limited collision zone is only possible with a small degree of curving of the rest position of the vocal fold edges in their ventral portion. This is an anatomical characteristic of the adult female larynx. Muscular fatigue and resulting hypotonia seem to enhance this curving. (3) If both these conditions are fulfilled, a sufficient vibration amplitude is required to achieve a localized impact. (4) This third condition can be obtained by an increased subglottal pressure and/or by a decrease in active stress of the tension forces between the neighboring vocalis masses. These last aspects incorporate muscular tension imbalance (dyskinesia) and behavioral aspects in the modelling process. Decrease in active stress is a possible effect of fatigue, and increase in subglottal pressure a result of effort compensation.

Experience with a medicolegal decision-making system for occupational hearing loss-related tinnitus.

Owing to an increasing number of requests for compensation, a medicolegal decision-making system for tinnitus related to noise-induced hearing loss (NIHL) has been elaborated at the Federal Belgian Institute of Occupational Diseases. Experience with 113 patients, all of them claiming compensation for NIHL and tinnitus, is now available. The patients underwent an exhaustive audiological investigation, and their professional career and noise exposure were carefully and objectively documented. We reviewed the group of 35 "accepted" cases (i.e., with chronic tinnitus recognized as related to NIHL and financially compensated as an occupational disease) and analyzed the medicolegal arguments for acceptance or rejection. In these patients, tinnitus was mostly bilateral, was perceived on average at a frequency of 4 KHz and with a supraliminal intensity of 7.2 dB, and lasted on average for 7.3 years. To gain better insight into the relationship between cochlear damage and chronic tinnitus, we compared our group to a control group of 35 patients with similar hearing thresholds at 3 and 4 KHz but free of tinnitus. The main difference is a significantly steeper slope of the audiometric curve between 2 and 3 KHz in the tinnitus group. Furthermore, a notch in the distortion product-gram is noticed in 60% of the ears affected by tinnitus versus 9% of the ears in the control group. This abrupt discontinuity in the activity along the tonotopic axis of the auditory system-the main characteristic of NIHL-could be a factor eliciting tinnitus, as a correspondence between the audiometric notch and tinnitus frequency appears to exist.

Asymmetry of Occupational Noise Induced Hearing Loss: An Electrophysiological Approach

Abstract Introduction The question as to whether occupational noise exposure causes symmetrical or asymmetrical hearing loss is still controversial and incompletely understood. Objective Two electrophysiological methods (cortical evoked response audiometry: CERA and auditory steady state responses: ASSR) were used to address this issue. Method 156 subjects with a well-documented history of noise exposure, a wide range of noise induced hearing loss (NIHL) and without middle ear pathology underwent both a CERA and an ASSR examination in the context of an exhaustive medicolegal expert assessment intended for possible compensation. Results Whatever the method (CERA or ASSR), the average electrophysiological hearing thresholds (1-2-3 kHz) are significantly worse in the left ear. The right - left differences in CERA and ASSR thresholds are strongly correlated with each other. No significant effect of frequency is found. No correlation is observed between right - left differences in hearing thresholds and either age or degree of hearing loss. Conclusion In NIHL, there is an actual average right - left difference of about 2.23 dB, i.e., 3.2%, the left ear being more impaired.

The effect of visible speech in the perceptual rating of pathological voices.

OBJECTIVE: To test a simple method for improving consistency among raters for the perceptual evaluation of pathological voice quality by providing visible speech (spectrogram) as additional information because, to date, the interrater variability still limits the widespread clinical use of the best available rating system. DESIGN: Experimental comparison between 2 different ways (with and without the addition of visible speech) of perceptual rating by trained professionals of recorded pathological voices. Furthermore, the correlation between acoustical (jitter, shimmer, and noise-harmonic ratio) and perceptual parameters was investigated in both rating conditions. SUBJECTS: Six experts evaluated 70 recorded pathological voices using the GIRBAS (grade, instability, roughness, breathiness, asthenicity, and strain) scale in 2 separate sessions: first, conventionally, without visible speech as additional information, and several months later, with visible speech as additional information. MAIN OUTCOME MEASURES: The kappa interrater agreement and the correlation coefficient between GIRBAS scores and acoustic measures. RESULTS: We found a significant effect of visible speech on the agreement between the raters. The interrater agreement according to kappa statistics was significantly stronger with the addition of visible speech than without for rating grade, roughness, and breathiness. The correlation between acoustical and perceptual parameters showed no significant effect of visible speech. CONCLUSIONS: The addition of visible speech to the perceptual evaluation of pathological voices is an interesting clinical asset to enhance its reliability. The addition of visible speech to the clinical setting is feasible, since affordable computer programs are currently available that can provide the spectrogram in quasi-real time while conversing with the patient. The acoustical analysis might be applied in addition to perceptual rating in a multidimensional approach to assess voice quality.

Dynamics of the Driving Force During the Normal Vocal Fold Vibration Cycle.

Intraglottal pressure is the driving force of vocal fold vibration. Theoretically, simultaneous quantification of glottal area and transglottal airflow allows the calculation of the intraglottal pressure waveform during a single vibration cycle. In this study, we show that, by combining photoglottography (transglottal light transmission) and airflow (Rothenberg mask) measurements during sustained vocal emissions in vivo, the intraglottal pressure wave can be approximated in a way similar to what has been done in models. The results confirm in vivo that the intraglottal pressure is systematically larger during the opening phase than during the closing phase, so that over one whole cycle, the driving force performs net positive work, accounting for sustained vocal fold motion. A component of this driving force asymmetry is related to vocal tract inertance, which also accounts for the skewing of the airflow waveform compared with the area waveform. Furthermore, the intraglottal pressure ratio (opening:closing) increases with voicing intensity, reaches a maximum around 76 dB, and significantly decreases at higher intensities. This rise and fall suggests that there is a range of intensity values in which, mechanically, a maximum of the driving force is imparted to the vocal fold mass. This finding could have implications for voice economy in professional speakers.

Multidimensional Assessment of the Effectiveness of Group Voice Therapy.

OBJECTIVE: Group voice therapy has been successfully used in patients with dysphonia, but there is little objectively documented evidence of its effects on voice quality and the self-perception of voice fatigue. The aim of this study was to investigate the effectiveness of group therapy in patients with functional dysphonia and minor anatomic vocal fold pathologies linked by appearance and history to voice use in an objective and multidimensional manner. STUDY DESIGN: This is a prospective longitudinal study. METHODS: Before and after treatment, 34 adult women underwent perceptual voice assessments using the grade of dysphonia, roughness, breathiness, asthenia, and strain (GRBAS) scale, Evaluation Vocale Assistée (EVA) system aerodynamic and acoustic assessments, and maximum phonation time measurements, and made subjective evaluations using the Voice Handicap Index. The pretreatment baseline values of the participants were obtained by means of two examinations separated by an interval of 1 week. The parameters belonging to each main dimension were clustered by means of Z-transformation, and the corresponding Z-scores were analyzed. RESULTS: Group therapy was associated with a statistically significant improvement in the perceptual (P = 0.008), acoustic (P = 0.040), aerodynamic (P = 0.009 and <0.001), and self-evaluation parameters (P = 0.011). CONCLUSIONS: Our findings provide evidence that group voice therapy can be associated with improvements in perceptual, acoustic, aerodynamic, and self-evaluated parameters in some patients with dysphonia. Controlled, randomized studies are needed in follow-up. This method of treatment may be a means of reducing the costs and waiting lists associated with rehabilitative treatment, and enhancing patients' motivation and compliance.