Voice activity and participation profile in assessing the effects of voice disorders on quality of life: estimation of the validity, reliability and responsiveness of the Finnish version.

AIM: The purpose of this study was to evaluate the validity, reliability and responsiveness of the Finnish version of the Voice Activity and Participation Profile (VAPP), a self-assessment questionnaire to measure psychosocial limitations caused by voice disorders. METHODS: The study was conducted in Tampere University Hospital in 2004 and 2005. Voice patients (n = 142) with diverse chronic voice pathologies received 3-5 sessions of voice therapy. Controls were known individuals with healthy voices (n = 127). The VAPP form was completed before attending hospital, at the first visit to hospital and before and after voice therapy. RESULTS: When comparing patients with healthy controls significant differences were found in score means. After brief voice therapy, the VAPP values improved moderately as 60% of patients had effect size of 0.27 or over. Physicians' advice did not improve VAPP scores. The VAPP question profile was regarded as consistent. Cronbach's alpha for the question profile was 0.958 and for the subsections 0.865. CONCLUSIONS: VAPP appeared to be valid and responsive to the intervention. In test-retest reliability, although intraclass correlation was high (0.905), there was a trend for the second answers to be better than the first. Some proposals are given to improve the practicality of the VAPP form.

Voice Activity and Participation Profile (VAPP) in assessing the effects of voice disorders on patients' quality of life: validity and reliability of the Finnish version of VAPP.

The Voice Activity and Participation Profile (VAPP) is a self-assessment questionnaire describing the limitation of activities and participation of individuals with dysphonia. In this study, the validity and reliability of the Finnish translation of the VAPP was evaluated using 43 outpatients with various functional and organic voice disorders. A control group was formed consisting of 43 subjects matched according to age, gender, and profession, with normal voices. The VAPP was sensitive for voice disorders and items in the questionnaire had high internal consistency. The VAPP had a strong correlation with the Voice Handicap Index. The results showed that the questionnaire is a valid and reliable instrument to measure voice-related quality of life. It also showed that limitations in activity and participation levels should be examined separately.

Effects of HearFones on speaking and singing voice quality.

HearFones (HF) have been designed to enhance auditory feedback during phonation. This study investigated the effects of HF (1) on sound perceivable by the subject, (2) on voice quality in reading and singing, and (3) on voice production in speech and singing at the same pitch and sound level. Test 1: Text reading was recorded with two identical microphones in the ears of a subject. One ear was covered with HF, and the other was free. Four subjects attended this test. Tests 2 and 3: A reading sample was recorded from 13 subjects and a song from 12 subjects without and with HF on. Test 4: Six females repeated [pa:p:a] in speaking and singing modes without and with HF on same pitch and sound level. Long-term average spectra were made (Tests 1-3), and formant frequencies, fundamental frequency, and sound level were measured (Tests 2 and 3). Subglottic pressure was estimated from oral pressure in [p], and simultaneously electroglottography (EGG) was registered during voicing on [a:] (Test 4). Voice quality in speech and singing was evaluated by three professional voice trainers (Tests 2-4). HF seemed to enhance sound perceivable at the whole range studied (0-8 kHz), with the greatest enhancement (up to ca 25 dB) being at 1-3 kHz and at 4-7 kHz. The subjects tended to decrease loudness with HF (when sound level was not being monitored). In more than half of the cases, voice quality was evaluated "less strained" and "better controlled" with HF. When pitch and loudness were constant, no clear differences were heard but closed quotient of the EGG signal was higher and the signal more skewed, suggesting a better glottal closure and/or diminished activity of the thyroarytenoid muscle.

Loading-related subjective symptoms during a vocal loading test with special reference to gender and some ergonomic factors.

Vocal loading-related subjective symptoms were studied in a day-long vocal loading test. The voices of 40 female and 40 male voluntary young students were loaded by having them read aloud a novel for five times 45 min. The subjective symptoms that occurred during the vocal loading session were reported by filling in a questionnaire after each session. The responses loaded on five factors in a factor analysis: (1) 'central fatigue'; (2) 'symptoms of the neck, shoulders and back'; (3) 'drying in the mouth and throat'; (4) 'symptoms of the throat'; (5) 'symptoms of the voice'. The exposure groups (5 females and 5 males per cell) consisted of eight combinations of the following factors: (1) low (25 +/- 5%) or high (65 +/- 5%) relative humidity of ambient air; (2) low [<65 dB(SPL)] or high [>65 dB(SPL)] speech output level of vocal loading; (3) sitting or standing posture during vocal loading. The lowest mean score for symptoms pooled over the test were found in 'symptoms of the neck, shoulders and back' and the highest mean symptom score in 'drying in the mouth and throat' and 'symptoms of the throat'. Most symptoms were at their minimum during the first loading session and increased statistically significantly to a peak mean value after three or five vocal loading sessions. Statistically significant differences in the mean level between the gender or exposure groups emerged for 'central fatigue' (humidity had clear effects) and 'symptoms of the neck, shoulders and back' (gender, humidity and posture had clear effects). In these cases, females had more symptoms than males; the low-humidity group had more symptoms than the high-humidity group, and the standing subjects had more symptoms than the sitting subjects.