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PubMedDate not supplied

Reliability and applicability of aerodynamic measures in dysphonia assessment.

Aerodynamic measures are frequently used to analyse and document pathological voices. Some normative data are available for speakers from the English-speaking population. However, no data are available yet for Chinese speakers despite the fact that they are one of the largest populations in the world. The high variability of aerodynamic measures between and within subjects raises the issue of reliability and usefulness of this procedure in discriminating between normal and pathological voices. This study aimed to investigate the use of mean airflow rate and sub-glottal pressure in predicting normal and pathological voices. It also aimed to determine whether a higher number of repeated airflow measures would provide a better representation of the normative data in distinguishing normal from abnormal voices. The study provided a small set of preliminary normative data for Chinese speakers. Aerodynamic measures were collected from 56 Cantonese female adults using a Kay Elemetrics Aerophone II. The results showed that the accuracy in predicting a voice to be dysphonic or normal using aerodynamic measures was as high as 91.1%. The accuracy was found to improve when the number of measurements for each aerodynamic parameter was increased from three to five. The overlapping of data between the dysphonic and non-dysphonic groups, however, suggests that the aerodynamic measures should be used as an adjunct to assessment of voice disorders rather than as a diagnostic tool alone.

Adult↗
PubMed2004

Outcome of laryngeal and velopharyngeal biofeedback treatment in children and young adults: a pilot study.

A relatively new management strategy for the treatment of voice disorders is the use of laryngeal (LB) and velopharyngeal biofeedback (VB). The main purpose of the present pilot study is to document the outcome of vocal and velopharyngeal performances after a well-defined LB and VB treatment. Four subjects were studied pretreatment (1 week before LB or VB treatment) and posttreatment (1 week after the LB or VB treatment). To measure and compare the effect of LB and VB, objective and subjective assessment techniques were used. Perceptual voice assessment included a perceptual rating of the voice using the GRBAS scale. Furthermore, the vocal quality in this population is modeled by means of the Dysphonia Severity Index. For the objective assessment of nasal resonance, the Nasometer and the Glatzel test were used. A perceptual evaluation of speech, the Gutzmann test, and the tests from Bzoch were used as subjective assessment techniques. Both patients selected for LB and VB treatment showed improvement of their performances. The resulting improvement, as measured by means of an objective approach, is in agreement with the perceived (auditory) improvement of voice and resonance. The use of LB and VB treatment in patients, especially in some subjects who are not responding to traditional voice or velopharyngeal therapy, must be encouraged.

Adolescent↗
PubMed1991

School-aged children with phonologic disorders: coexistence with other speech/language disorders.

Subjects in grades 1-12 with phonologic disorders were identified and categorized into either Residual or Delayed groups. Group selection was based on a subject rating system of communicative defectiveness and number and type of phonologic errors. The subjects' performance was compared with that of normal individuals on a number of speech and language parameters. The results indicated that voice disorders, deficits in expressive language, and hearing problems occurred in persons exhibiting phonologic disorders with a higher frequency than in the normal individuals.

Adolescent↗
PubMed2004

Factors predicting patient perception of dysphonia caused by benign vocal fold lesions.

OBJECTIVES/HYPOTHESIS: To assess factors that may be predictive of patient perception of dysphonia severity, as quantified by the Voice Handicap Index (VHI) score. We hypothesize that 1) level of vocal demand; 2) auditory-perceptual evaluation of dysphonia severity; and 3) vocal function, as defined by phonatory glottal closure and mucosal wave vibration, are the most significant predictors of VHI score. STUDY DESIGN: : Retrospective review of 100 patients with benign vocal fold lesions. METHODS: Variables assessed for predictive value to VHI score are level of vocal demands, auditory-perceptual evaluation of dysphonia severity, integrity of mucosal wave vibration and phonatory glottal closure, lesion type, duration of current complaint, smoking, age, and sex. Harmonic to noise ratio was assessed in a subset of 50 patients. RESULTS: Patients with routine voice use had significantly lower VHI scores than those with more intensive (nonsinging/acting) vocal demands. Patients who quit smoking had greater VHI scores than those who currently smoke or never started. Patients with long-standing dysphonia tended to have lower VHI scores than those with shorter duration vocal complaints. Auditory-perceptual assessment of dysphonia severity and harmonic to noise ratio were weak predictors of VHI score. Age, sex, lesion type, phonatory glottal closure, and mucosal wave vibration were not significant predictors of VHI score. CONCLUSIONS: Patient perception of dysphonia severity is independent of many factors commonly assessed during the evaluation of voice disorders. It appears to be an important independent element in the assessment of the effect of a benign vocal fold lesion and critical to therapeutic decision-making.

Adolescent↗
PubMed2006

Care of the vocalist: an uncommon perspective in rehabilitative medicine.

Neurogenic communication disorders are a routine component of clinical practice in physiatry. The organicity of motor speech impairments and of forms of dysphagia is a basic, recurring element of clinical practice in physical and rehabilitative medicine. The purpose of this article is to provide an overview of some forms of and causes for predictable dysphonias associated with professional voice use. Intended as a synopsis of hyperfunctional voice disorders associated with professional voice use, only certain laryngeal pathologies with functional etiology and their effects on phonation are acknowledged.

Disability Evaluation↗
PubMed2006

Influence of age and gender on the dysphonia severity index. A study of normative values.

Attempts have been made to find objective parameters for assessing voice quality for many years. Objective measurements such as the dysphonia severity index (DSI), using four parameters (highest frequency, lowest intensity, maximum phonation time and jitter), appear to correlate well with perceptual evaluation. The aim of this study was to investigate the influence, if any, of age and gender on the DSI. The DSI of 118 non-smoking adults (69 females, 49 males, age range 20-79 years) without voice complaints was measured. Age has a significant effect on the DSI and on its parameters highest frequency and lowest intensity (only in females). Gender has no effect on the DSI, although it has a significant effect on the parameters highest frequency and maximum phonation time. To be able to distinguish between the effects of (normal) ageing and a voice disorder, normative data of a wide age range are essential. As a result of this study normative DSI values for gender and age have been made available.

Adult↗
PubMed2000

The frequency of hard glottal attacks in patients with muscle tension dysphonia, unilateral benign masses and bilateral benign masses.

Hard or abrupt glottal attack (HGA) is one of the vocal behaviors often associated with benign lesion of the vocal folds. This study was designed to determine whether the frequency of HGA was different in hyperfunctional voice patients with and without vocal fold masses. One hundred and forty-seven subjects were studied. All subjects received a complete otolaryngological evaluation including strobovideolaryngoscopy, objective voice measures, and evaluation by a speech-language pathologist. Thirty-two patients were diagnosed with muscle tension dysphonia (19 male, 13 female) without vocal fold masses. Fifty-seven patients were diagnosed with unilateral vocal fold masses (29 male, 28 female), most of which were cysts. Fifty-eight patients were diagnosed with bilateral vocal fold masses (13 male, 45 female). Of the 45 females with bilateral vocal fold masses. 26 had a vocal cyst and reactive nodule and 19 had bilateral vocal fold nodules. The control group was balanced and matched based on sex and on percentage of singers and nonsingers. It consisted of 49 subjects with no vocal fold pathology (20 male, 29 female). The group was composed of professional speakers, singers, and nonprofessional speakers. All voice disordered groups demonstrated higher frequencies of HGA than the control group. Differences were found between the male and female subjects in this study. No differences were found between the various disorders. Differences were also found between the subgroups of bilateral masses, where the bilateral nodules group presented a higher frequency of HGA than the cyst and contralateral reactive nodule.

Adolescent↗
PubMed2002

Comparisons between therapists' and patients' views of dysphonia: a survey study.

Speech and language therapists (SLTs) recognise the need to involve patients in the design and implementation of services. The present study describes the results of a questionnaire survey undertaken among SLTs working with patients with voice disorders to determine whether patients' and therapists' views on issues around dysphonia were in harmony. The SLTs' views of patients' disabilities and handicaps associated with dysphonia are reported and compared with those of an earlier survey of patient-reported difficulties (Scott et al. Clin Otolaryngol 1997; 22: 37-40). A close, but incomplete, match of therapists' and patients' views of dysphonia is reported and discussed.

Attitude to Health↗
PubMed2000

Acoustic and airflow spectral analysis of voice tremor.

Acoustic spectral analysis has been used to describe voice tremor with some success, but no feature distinguishing pathological from normal tremor has been clearly identified. To assist in monitoring voice tremor associated with neurological diseases, objective and quantifiable measures that can distinguish between normal and pathological tremor are desired. This study explored the plausibility of using airflow and acoustic signals to quantify the frequency and amplitude of voice tremor and potentially to distinguish pathological from normal tremor. Subjects were 10 individuals with pathological tremor, most of them individuals with Parkinson's disease, and 10 gender and age-matched individuals with no voice disorder. Simultaneous acoustic and airflow signals were recorded during sustained vowel phonation. The acoustic intensity contours and the airflow signals were submitted to spectral analysis. A peak prominence ratio, defined as the ratio of the spectral peak energy to the overall signal energy, was calculated for each spectral peak below 30 Hz. For each subject, the 6 spectral peaks with the highest peak prominence ratios were selected. Frequency values of the 6 selected acoustic or airflow spectral peaks failed to distinguish tremor group from control group. Peak prominence ratios of the 6 selected acoustic spectral peaks were significantly higher for tremor group than for control group. Although spectral analysis of airflow signals was not useful in differentiating tremor group from control group, acoustic intensity contours and airflow time waveforms were highly and positively correlated in more tremor subjects (90%) than control subjects (40%). This finding suggests that the relationship between acoustic intensity contours and airflow time waveforms may reflect the presence and the source of voice tremor.

Adult↗
PubMed2006

Validation of the voice handicap index using Rasch analysis.

BACKGROUND: The Voice Handicap Index is a tool for measuring the psychosocial consequences of voice disorders and consists of three dimensions. Previous psychometric evaluation of the VHI focused on the classic evaluation of reliability and validity, which is sample dependent. The authors used Rasch analysis to re-examine the dimensionality of the VHI and to produce item and scale statistics that are less sample dependent. In addition, they provide estimates of VHI item and person severities that are reported on the same logit unit scale, allowing a more straightforward interpretation of a VHI test score. PATIENTS: Dysphonic patients (N = 530), who were referred for phoniatric examination, filled out the VHI. RESULTS: Rasch analysis revealed two truly uni-dimensional constructs: the 20-item psychosocial scale and the 9-item physical-functional scale. Logit item severity measures ranged from -2.1 to +2.7. Person severity scores ranged from -4.4 to + 4.4 logits. The internal consistency of the reduced scales was similar to that of the original total VHI (0.95 and 0.84). The VHI consisted of two uni-dimensional constructs. Raw test scores can be transformed into logit unit severity measures, making the VHI more suitable for evaluating the effectiveness of voice-related therapy.

Adult↗
PubMed1993

Fundamental frequency stability in functional dysphonia.

Functional dysphonia is a term applied to voice disorders for which there is an absence of apparent structural change in the larynx. The aim of this work was to investigate how functional dysphonia may differ acoustically from other types of dysphonia. Fundamental frequency profiles for steady vowels were generated using a software program called GLIMPES (Glottal Imaging by Processing External Signals). The fundamental frequency variations were found to be unimodal in normal individuals. In contrast, the variations for dysphonic patients were sometimes bi-modal or multi-modal due to the presence of subharmonics or low-frequency modulations. The appearance of these patterns was generally related to the severity of the dysphonia rather than to its etiology.

Adolescent↗
PubMed1991

[Computer-assisted phonetography as a diagnostic aid in functional dysphonia].

A total of 160 voice-trained and untrained subjects with functional dysphonia were given a "clinical rating" according to their clinical findings. This was a certain value on a scale that recorded the degree of functional voice disorder ranging from a marked hypofunction to an extreme hyperfunction. The phonetograms of these patients were approximated by ellipses, whereby the definition and quantitative recording of several phonetogram parameters were rendered possible. By means of a linear combination of phonetogram parameters, a "calculated assessment" was obtained for each patient that was expected to tally with the "clinical rating". This paper demonstrates that a graduation of the dysphonic clinical picture with regard to the presence of hypofunctional or hyperfunctional components is possible via computerised phonetogram evaluation. In this case, the "calculated assessments" for both male and female singers and non-singers must be computed using different linear combinations. The method can be introduced as a supplementary diagnostic procedure in the diagnosis of functional dysphonia.

Adolescent↗
PubMed1978

[Examination of patients with normal and abnormal voice by pneumotachography (author's transl)].

22 patients with normal vocal function and 33 with voice disorders were examined by pneumotachography. The degree of air-flow speed during phonation, the volume of air during phonation, and the duration of phonation were studied in 17 dysphonic patients with complete closure of the glottis, 16 patients with incomplete glottic closure, and 19 euphonic (control) patients. The following results were obtained: 1. The parameters of the study are dependent upon the intensity of phonation. 2. The values of the normal group and the dysphonic patients with complete closure of the glottis during phonation are approximately the same. 3. The values of dysphonic patients with incomplete closure of the glottis are significantly different from the other two groups. According to the results obtained, pneumotachography appears to be a useful method in the evaluation of laryngeal function. Its advantage consists of determining measurable values which are particularly important for followup examinations during treatment. However, the procedure should be used only as part of the complete phoniatric examination.

Air↗
PubMed2005

Comparing outcomes of voice therapy: a benchmarking study using the therapy outcome measure.

The quality cycle requires clinicians to assess the outcomes of interventions. Benchmarking is an approach that has been advocated to compare current performance across different services to identify commonalities and significant differences. This article gives the results of a study of outcomes in speech and language therapy (SLT) using the therapy outcome measure (TOM) for patients with voice disorder (dysphonia) comparing outcomes of seven separate speech and language therapy services. The study aimed to identify the similarities and differences in outcomes of care provided by different services. Two hundred and forty patients with dysphonia (age range 3-87.5 years, average 51.9 years) were treated. The results indicated that although there was no significant difference in the profile of the severity of symptomology of patients referred to speech and language therapy in different geographical areas, there was a significant difference in the treatment outcomes across the services and in the stated reason for discharge from treatment. Nevertheless, most patients with dysphonia had a good outcome and this was associated with completion of the course of treatment. There were significant differences in the number of treatment contacts provided by the different services and in the duration (between admission and discharge) of treatment across the services. Benchmarking can provide useful information through use of routinely collected clinical data.

Adolescent↗
PubMed2005

Task specificity in adductor spasmodic dysphonia versus muscle tension dysphonia.

OBJECTIVES: Adductor spasmodic dysphonia (ADSD) has been characterized as a "task specific" laryngeal dystonia, meaning that the severity of dysphonia varies depending on the demands of the vocal task. Voice produced in connected speech as compared with sustained vowels is said to provoke more frequent and severe laryngeal spasms. This study examined the diagnostic value of "task specificity" as a marker of ADSD and its potential to differentiate ADSD from muscle tension dysphonia (MTD), a functional voice disorder that can often masquerade as ADSD. STUDY DESIGN: Case-control study. METHODS: Five listeners, blinded to the purpose of the study, used a 10 cm visual analogue scale to rate dysphonia severity of subjects with ADSD (n = 36) and MTD (n = 45) producing either connected speech or a sustained vowel "ah." RESULTS: In ADSD, dysphonia severity for connected speech (M = 6.22 cm, SD = 2.56) was rated significantly more severe than sustained vowel productions (M = 4.8 cm, SD = 2.8 [t (35) = 3.67, P < .001]). In MTD, however, no significant difference in severity was observed for the connected speech sample (M = 5.98 cm, SD = 2.83 versus the sustained vowel M = 5.86 cm, SD = 2.87 [t (44) = 0.378, P = .707]). The receiver operating characteristic (ROC) curve, an index of the accuracy of task specificity as a diagnostic marker, revealed that a 1 cm difference criterion correctly identified 53% of ADSD cases (sensitivity) and 76% of MTD cases (specificity) (chi2 (1) = 6.88, P = .0087). CONCLUSIONS: Reduced dysphonia severity during sustained vowels supports task specificity in ADSD but not MTD and highlights a valuable diagnostic marker whose recognition should contribute to improved diagnostic precision.

Adult↗
PubMed1995

Speech task effects on acoustic and aerodynamic measures of women with vocal nodules.

Vowel prolongation is often used to evaluate disordered voice production. In light of previous findings showing that co-articulation has significant influence on laryngeal function measures, the practice of using prolonged vowels to represent a speech sample is questioned. To test whether disordered and normal voice during vowel production is generalizable to connected speech, three speaking tasks were investigated: sustained vowel prolongation, syllable repetition and reading. Statistical differences were found between these tasks for certain amplitude and time based laryngeal function measures for adult women with disordered and normal voice. However, for the specific measures which were statistically different, the actual numerical and perceptual differences may be quite small. From a clinical assessment standpoint, the choice of the speech task may not make an apparent difference in the objective evaluation of disordered voice.

Adult↗