Vocal Health Education in Undergraduate Performing Arts Training Programs
Journal of Voice
SUMMARY
Purpose
Vocal health is taught in multiple formats and to varying degrees across undergraduate training programs. The aim of the study is to identify what methods of instruction lead to a better self-perception of vocal health in order to more adequately prepare graduates for the extreme demands of the performing arts industry.
Method
A survey investigating how vocal health and vocal injury are being taught was administered to students within 5 years of graduation. This study looked at what type of information is taught, when information is presented, how prepared students feel they are to handle their health and injuries upon graduation, the prevalence of injuries while in school and during the first 5 years of postgraduation, and students' suggestions to improve their overall vocal health education. The survey compares vocal health education between the various disciplines of classical voice, musical theatre, and acting.
Results
Students learn more about general vocal hygiene than voice disorders in their undergraduate programs. Classical voice and musical theatre majors learn more about vocal health than acting majors, yet acting majors report a higher incidence of vocal injury within the first 5 years of graduation. Students also retain more vocal health knowledge when presented with information multiple times in their education.
Conclusions
Creating a more specific, consistent vocal health curriculum for all voice-related performing arts programs will improve self-efficacy regarding vocal health upon graduation.
Correspondence information about the author Laura L.O. Froeschke
Email the author Laura L.O. FroeschkeJournal of Voice
Summary
Introduction
Adductor Spasmodic Dysphonia (ADSD), a form of focal dystonia, has been defined as a neurogenic, task-specific disorder characterized by abrupt spasms of intrinsic laryngeal muscles that result in phonatory breaks. Voice breaks are typically isolated to propositional speech, and reported to increase in severity as speaking demand or complexity increases. Research to date has focused on variations in phonologic contexts and their influence on voice breaks. The influences of variables at lexical and syntactic levels of analysis have been less well-researched and yet may provide insight into observed variability of symptom manifestation in this rare voice disorder.
Objectives
This study investigated frequency of voice breaks over 20 standard sentences in 38 individuals with ADSD according to linguistic complexity measures including lexical density and a four-level lexical frequency and type paradigm. Two research questions about linguistic influences and ADSD symptom manifestation were posed: (1) does the frequency of voice breaks vary according to the lexical density of a string? and (2) does the frequency of voice breaks vary according to a measure of lexical frequency/type?
Results
Results revealed a nonsignificant relationship between string length and voice break frequency, whereas a significant relationship was found between lexical density and voice break frequency (P = 0.029, r = 0.488). Lexical analysis results revealed a significant relationship between lexical frequency and voice breaks, with words within technical/academic classes relating to the highest rates of voice break across 38 subjects with ADSD.
Conclusions
Results from this secondary analysis provide support for the hypothesis that variation in linguistic demand may modulate symptom expression in SD. Specifically, lexical density and lexical frequency modulated the frequency of symptom expression in classic forms of SD in this purposive sample.
Journal of Voice
ABSTRACT
There is a high prevalence of dysphonia among professional voice users and the impact of the disordered voice on the speaker is well documented. However, there is minimal research on the impact of the disordered voice on the listener. Considering that professional voice users include teachers and air-traffic controllers, among others, it is imperative to determine the impact of a disordered voice on the listener. To address this, the objectives of the current study included: (1) determine whether there are differences in speech intelligibility between individuals with healthy voices and those with dysphonia; (2) understand whether cognitive-perceptual strategies increase speech intelligibility for dysphonic speakers; and (3) determine the relationship between subjective voice quality ratings and speech intelligibility. Sentence stimuli were recorded from 12 speakers with dysphonia and four age- and gender-matched typical, healthy speakers and presented to 129 healthy listeners divided into one of three strategy groups (ie, control, acknowledgement, and listener strategies). Four expert raters also completed a perceptual voice assessment using the Consensus Assessment Perceptual Evaluation of Voice for each speaker. Results indicated that dysphonic voices were significantly less intelligible than healthy voices (P ≤ 0.001) and the use of cognitive-perceptual strategies provided to the listener did not significantly improve speech intelligibility scores (P = 0.602). Using the subjective voice quality ratings, regression analysis found that breathiness was able to predict 41% of the variance associated with number of errors (P = 0.008). Overall results of the study suggest that speakers with dysphonia demonstrate reduced speech intelligibility and that providing the listener with specific strategies may not result in improved intelligibility.
Journal of Voice
Summary
Objective
The study aimed to determine the normative value of SVHI-10.
Study Design
The study is a systematic review and a meta-analysis.
Methods
A systematic literature search was performed using PubMed and ScienceDirect to access relevant databases and to locate outcome studies. Eligibility criteria included type of publication, participant characteristics, and report of outcomes. Data analysis was conducted using the meta-analysis method.
Results
Six articles were included for the final analysis. The normative values for the SVHI-10 for a group of 528 subjects were 8.38 with confidence levels of 7.43–9.34 (age range 16–83).
Conclusions
Based on the results of the meta-analysis the SVHI-10 can be used as a screening tool for a group of singers. In the future, it would be worthwhile to carry out a subordinate analysis to determine the SVHI-10 range for mild voice disorders or severe voice disorders in singing.
Journal of Voice
Summary
This study examined the knowledge gained and behavioral changes made by vocal performers after attending a vocal hygiene education program. A single-group, pretest-posttest research design was utilized to examine the improvement of voice care knowledge and decrease of phonotraumatic behaviors in vocal performers. Data analysis involved a comparison of pretest and posttest responses from an online questionnaire. A paired sample t test revealed a statistically significant improvement in the participants' knowledge regarding the larynx, voice production, and vocal hygiene. In addition, a behavioral inventory revealed improved hydration habits, decreased caffeine and alcohol intake, and healthier responses to symptoms of throat irritation or vocal fatigue. The findings from this study will contribute to evidence regarding the benefits of having vocal performers attend a vocal hygiene education program in order to increase their knowledge about voice production and care, decrease at-risk vocal behaviors, and improve healthy vocal practices.
Journal of Voice
Summary
Background
The study evaluates clinical features of vocal fold (VF) leukoplakia in predicting its benign or malignant nature.
Materials
57 patients with 84 lesions were evaluated before undergoing laryngeal microsurgery. The texture, color, thickness and size of the leukoplakia, along with an assessment of the surrounding mucosa vascularization using narrow-band imaging (NBI), and VF vibratory function were analyzed. Receiver-operating characteristic curves were constructed to determine the predictive value of each feature and area under the curve (AUC) was calculated.
Results
Histopathological examination revealed high-grade dysplasia or invasive cancer in 13 of VF leukoplakia. Seventy-one lesions were nondysplastic or low-grade dysplasia. Nonhomogenous color, irregular texture, and prominent thickness predicted malignancy with statistical significance (P < 0.05). AUC was 0.793, 0.793, and 0.679, respectively. Absence of a mucosal wave on laryngovideostroboscopy was significant for the detection of malignancy (P < 0.001) with an AUC of 0.927. The NBI diagnosis of horizontal vessel loops was significant with the highest AUC of 0.993.
Conclusions
The comprehensive clinical evaluation of VF leukoplakia with laryngovideostroboscopy and NBI creates the opportunity to differentiate between low- and high-risk malignancy lesions. The perpendicular vascular pattern and the limited or absent mucosal wave appear to be the most powerful indicators of malignancy.
Journal of Voice
Summary
Objective
To analyze the Acoustic Voice Quality Index (AVQI) and the Acoustic Breathiness Index (ABI) concurrent validity and diagnostic accuracy with different speech materials.
Methods
Voices of 53 subjects (40 dysphonic; 13 vocally health) were recorded: vowel /a/ + counting numbers 1–20 (42 syllables) + reading text (138 syllables). Numbers and text were edited in order to achieve 3 seconds of voiced segments, such as the vowel /a/ (average of 18.81 and 32.49 syllables; confidence interval of 1.87 and 2.30). The audio files were edited to have 17 syllables for numbers and 32 for text. Three voice specialists perceptually judge the overall voice quality (G) and the breathiness (B). AVQI's and ABI's precision and concurrent validity were assessed.
Results
The intra- and inter-rater reliability were high. Reading text presented higher concurrent validity (r) than automatic speech and excellent area under the receiver-operating characteristic curve for AVQI (0.963) and ABI (0.929). Counting numbers presented good area under the receiver-operating characteristic curve for AVQI (0.870) and excellent for ABI (0.924). Counting numbers produced higher sensitivity for ABI (95.2%) and reading text higher specificity for both indexes (AVQI = 100%; ABI = 90.90%). Reading text presented higher AVQI and ABI scores than numbers, therefore, reading seems to reveal more vocal deviations; however, perceptual judgment can be similar in both samples.
Conclusions
Different speech materials may impact acoustic outcomes and certain voice characteristics may not be evident. Reading text offers higher diagnostic accuracy. Clinician and/or researchers must select and standardize the speech sample according to their goals.
Journal of Voice
Summary
Objectives
A major limitation of comparing the efficacy of videostroboscopy (VS) and high-speed videoendoscopy (HSV) is the lack of an objective reference by which to compare the functional assessment ratings of the two techniques. For patients with vocal fold mass lesions, intraoperative measures of lesion size and depth may serve as this objective reference. This study compared the relationships between the pre- to postoperative change in VS and HSV visual-perceptual ratings to intraoperative measures of lesion size and depth.
Design
Prospective visual-perceptual study with intraoperative measures of lesion size and depth.
Methods
VS and HSV samples were obtained preoperatively and postoperatively from 28 patients with vocal fold lesions and from 17 vocally healthy controls. Two experienced clinicians rated amplitude, mucosal wave, vertical phase difference, left-right phase asymmetry, and vocal fold edge on a visual-analog scale using both imaging techniques. The change in perioperative ratings from VS and HSV was compared between groups and correlated to intraoperative measures of lesion size and depth.
Results
HSV was as reliable as VS for ratings of amplitude and edge, and substantially more reliable for ratings of mucosal wave and left-right phase asymmetry. Both VS and HSV had mild-moderate correlations between change in perioperative ratings and intraoperative measures of lesion area. Change in function could be obtained in more patients and for more parameters using HSV than VS. Group differences were noted for postoperative ratings of amplitude and edge; however, these differences were within one level of the visual-perceptual rating scale. The presence of asynchronicity in VS recordings renders vibratory features either uninterpretable or potentially distorted and thus should not be rated.
Conclusions
Amplitude and edge are robust vibratory measures for perioperative functional assessment, regardless of imaging modality. HSV is indicated for evaluation of subepithelial lesions or if asynchronicity is present in the VS image sequence.
Journal of Voice
Summary
Hyaluronic acid injection for medialization laryngoplasty is a safe procedure performed on patients with glottic incompetence. Laryngeal abscess formation as a complication of injection laryngoplasty is a very rare complication, and, as we know from the literature, there has been only one case of laryngeal abscess after injection laryngoplasty in a patient with a type-I laryngeal cleft. We document for the first time a laryngeal abscess resulting from hyaluronic acid injection laryngoplasty for unilateral vocal fold paralysis. Prompt evaluation of the patient was necessary. Our patient was treated with antibiotics and corticosteroids without a need for intubation. One year after injection, the patient's Voice Handicap Index-10 score was still good and within the range of normal values.
Journal of Voice
Summary
Introduction
In individuals with Parkinson's disease (PD), pulmonary complication such as weakness and rigidity of respiratory muscles and reduced cough airflow may be associated with reduced voice production due to limited pulmonary capacity and reduced airflow needed to vibrate the vocal folds. It is not clear, however, which pulmonary function parameter is determinant in the association with peak subglottic pressure (SGP). Therefore, the purpose of this study was to determine the association between peak SGP and pulmonary function parameters in individuals with PD.
Methods
Forty-two individuals with diagnosis of idiopathic PD of both genders were recruited in the study. Mean and peak SGP, spirometric indices, maximum inspiratory pressure, maximum expiratory pressure (MEP), and peak cough flow (PCF) during reflex and voluntary cough were measured on all participants.
Results
The analysis revealed that peak SGP had a moderate but significant linear association with MEP (r = 0.38; P = 0.013), voluntary (r = 0.31; P= 0.051), and reflex PCF (r = 0.40; P = 0.012), but not with maximum inspiratory pressure (r = 0.23; P = 0.145). Higher values in peak SGP were associated with higher values in MEP, voluntary PCF, and reflex PCF. No linear association was detected between peak SGP and spirometric indices.
Conclusions
Peak SGP has a direct association with voluntary and reflex PCF, and expiratory muscle strength, but not with inspiratory muscle strength. The association with peak SGP is higher for reflex PCF than for voluntary PCF.
Journal of Voice
Abstract
The purpose of this study was to comprehensively evaluate voice and speech changes in one healthy 30-year-old transgender male undergoing testosterone therapy for transition. Testing occurred at three timepoints before cross-sex hormone therapy and every 2 weeks thereafter for 1 year. Data collected included measures of acoustics, aerodynamics, and laryngeal structure and function via flexible laryngoscopy. Analysis included acoustic correlates of pitch, loudness, voice quality, and vocal tract length, as well as perceptual measures of voice quality and gender. Speaking fundamental frequency (fo) lowered from 183 Hz to 134 Hz. Phonatory frequency range (ie, minimum and maximum singing range) shifted from a range of D#3–E6 to a range of A2–A5. Perceptual measures of voice quality indicated no negative changes. Naïve listeners reliably rated the participant's speech samples as male after 37 weeks on testosterone. Few studies document in detail the variety of voice changes that occur during cross-sex hormone therapy, focusing instead on fo alone. This study adds to the literature a comprehensive case study of speech and voice changes experienced by one transmasculine participant undergoing testosterone therapy.
Journal of Voice
Abstract
Objectives/Hypothesis
The goal of this study was to introduce two novel techniques in phonomicrosurgery, air injection (AIR), and transillumination (TI), to improve the diagnosis and surgical excision of pathological tissue in vocal folds during suspension laryngoscopy while preserving the healthy tissue as much as possible.
Study design
Prospective clinical case series.
Methods
Thirty-four patients with benign vocal cord lesions who underwent phonomicrosurgery between January 2016 and May 2017 were evaluated. Pre- and intraoperative recordings were evaluated by three experienced laryngologists. Stroboscopic video images taken during the preoperative diagnosis and interoperative video recordings made before and after AIR and TI were performed were reviewed and compared. During the preoperative evaluation, the surgeons declared their surgical plans and noted changes while observing the intraoperative evaluation during AIR and TI.
Results
Sixty-eight vocal folds were evaluated. The initial diagnosis was found to be consistent with the final diagnosis in only 10 patients (29.4%). The diagnoses of 29 vocal folds (42.6%) and the surgical plans changed after AIR and TI. In six cases, submucosal bands, additional morphological structures in the vicinity of the primary pathology, were observed; these could only be visualized with AIR and TI. AIR and TI revealed new pathologies in four vocal folds that were noted to be normal in the preoperative evaluation.
Conclusion
AIR and TI are useful and promising techniques to identify undiagnosed lesions in vocal folds and to increase the success of minimally invasive phonosurgery.
Journal of Voice
Abstract
Objective
To investigate the prevalence of phonatory and swallowing symptoms in patients with hypovitaminosis D.
Methods/Design
All patients presenting to the endocrinology clinic and investigated for vitamin D deficiency between January 2018 and April 2018 were asked to participate in this study. Demographic data included age, gender, allergy, and history of smoking. Patients filled Voice handicap Index (VHI-10) and Eating Assessment Tool (EAT-10).
Results
A total of 136 consecutive subjects presenting to the endocrinology clinic for vitamin D testing were included: 60 with hypovitaminosis D and 76 with no hypovitaminosis D. The mean vitamin D level in the study group and controls was 13.25 ng/mL and 31.91 ng/mL, respectively. There was no significant difference in the mean score of VHI-10, nor in the mean score of EAT-10 in patients with hypovitaminosis D versus those with no hypovitaminosis D (P value >0.05).
Conclusion
There was no significant difference in the prevalence of phonatory and dysphagia symptoms using VHI-10 and EAT-10 questionnaires between subjects with hypovitaminosis D and those with normal serum vitamin D levels.
Journal of Voice
ABSTRACT
Objectives
To discuss the presentation and management techniques of implant extrusion following type I thyroplasty and to illustrate the potential of strap muscle for augmentation following implant removal.
Methods
We report a unique case of a patient with late Gore-Tex implant extrusion after type I thyroplasty treated with removal and autologous strap muscle graft for augmentation.
Results
A 41-year-old female nearly 3.5 years status post Gore-Tex type I thyroplasty for left vocal fold paralysis presented for evaluation of dysphonia. Upon flexible laryngoscopy, erythema, edema, and granulation tissue were identified at the left vocal fold and ventricle. The patient subsequently underwent removal of her implant. Intraoperatively, a free portion of sternothyroid muscle was dissected free and placed into the paraglottic space. One month following surgery, the patient reported an improvement in her Voice Handicap Index (VHI) score from 40 to 0. In addition, no major complications were observed and complete glottic closure was achieved. Nine months postsurgery, she continued to function well with a VHI score of 0. At 50 months postop, the patient still reports a VHI score of 0.
Conclusions
Implant extrusion is a rare complication of type I thyroplasty usually occurring in the first few months after surgery and more commonly presenting in females. Current management options consist of observation or augmentation with autologous fat or vocal fold injection following implant removal. This is the first report of a successful strap muscle free graft revision thyroplasty following implant extrusion. The patient's excellent long-term outcome highlights the potential of strap muscle augmentation as a feasible management option for implant extrusion.
Journal of Voice
Summary
Objective
To evaluate the impact of group therapy in patients with dysphonia, as well as to verify the correlation between vocal symptoms and levels of anxiety.
Methods
The study was composed of 52 patients subdivided into two groups, named the Experimental Group (EG) with 28 volunteers and the Control Group (CG) with 24 volunteers. Anxiety and voice protocols were used for data collection. The State-Trait Anxiety Inventory (STAI) was used to measure trait levels of anxiety that after collection were categorized according to the variation in scores value: low anxiety (20-40 points); average anxiety (40-60 points); high anxiety (60-80 points). In addition, the Voice Symptom Scale (VoiSS) was used for voice assessment. Inferential statistical analysis from the Student's t test for paired and independent data, in order to compare the average scores of STAI trait levels and VoiSS domains of the pre- and postmoments, intra- and intergroups, EG and CG, respectively. For that purpose, the program Statistical Package for Social Sciences (SPSS) was used.
Results
Half of the patients in the survey presented an average trait level of anxiety. Regarding the EG, there was a significant reduction of state anxiety when comparing the moments before and after group therapy. There was also a significant reduction in the values of the VoiSS-Total and VoiSS-Physical domains when compared to the pre- and postgroup therapy moments. It was verified the existence of a positivecorrelation between the levels of anxiety after group therapy and VoiSS-Total, VoiSS-Limitation, and VoiSS-Physical domains. As for the CG, there was an increase in anxiety levels as well as in all domains of the VoiSS scale when compared to the pre- and postmoments.
Conclusions
Group voice therapy was effective for a significant reduction of vocal symptoms and anxiety – common conditions in patients with dysphonia. It was possible to perceive the positive correlation between anxiety levels and vocal symptoms.
Journal of Voice
Summary
Objectives
Vocal effort is often a symptom reported when a patient experiences a voice disorder. The aim of this investigation was to compare Voice Handicap Index (VHI) scores among patients with primary complaints of vocal effort (VE) versus vocal quality (VQ) and both vocal effort and quality (VQ+VE). A secondary aim was to compare Glottal Function Index (GFI), and glottic closure pattern between patients with the aforementioned primary presenting complaints and laryngeal pathology diagnosis.
Study Design
Prospective outcomes database design
Methods
Patients were identified with presenting complaints of VQ, VE, or VQ+VE who completed the VHI. Seven hundred and thirteen subjects who met criteria were categorized across three complaint groups and five laryngeal pathologies. Variables selected included age, gender, diagnosis, VHI, GFI, and 12-Item Short Form Health Survey. VHI and GFI scores were compared between the three presenting complaints. Relationships between the categorical variables and glottic closure were also assessed.
Results
Significant differences in total VHI were measured among all three presenting-complaint categories (P < 0.0001). Patients with VE only complaints had significantly greater VHI scores than those patients who report VQ only complaints. VHI scores were significantly higher for patients with combined complaints of VQ+VE as compared to VQ only or VE only. Significant differences in GFI were measured across all three complaints, and GFI was significantly higher in VE only as compared to VQ only (P < 0.001). Glottic closure pattern was not statistically significant in the variables examined. VHI scores were significantly different within pathology subgroups (P < 0.03).
Conclusion
VE only complaints affect quality of life with and without concomitant VQ complaints. Patients with VE complaints perceive a higher level of glottic dysfunction. An underlying mechanism for increased VE could be altered glottic function, however, we were unable to suggest a correlation between glottic closure and GFI.
Journal of Voice
Abstract
Importance
Prior studies have evaluated various populations at increased risk of voice impairment. However, minimal data is available for military Drill Instructors, a population known to have significant vocal demands.
Objective
The purpose of this study was to determine the prevalence of subjective, perceptual, and objective dysphonia in this population and to evaluate contributing factors and impact on job performance.
Design
Cross-sectional analysis.
Setting
United States Marine Corps base (Marine Corps Recruit Depot, San Diego, California).
Participants
Active US Marine Corps Drill Instructors.
Interventions
A survey was administered investigating subjective measures of dysphonia and its impact on occupational function. Standardized voice samples were recorded for objective and perceptual voice analysis.
Main Outcomes and Measures
Prevalence of subjective (Voice Handicap Index-10 and Glottal Function Index scores), perceptual (CAPE-V score), and acoustic (Cepstral-spectral index of dysphonia) measures of dysphonia.
Results
Subjective dysphonia was present in 47.7% by the Voice Handicap Index-10 and 70.2% by the Glottal Function Index. 51% of subjects reported periods of aphonia, while 47% reported voice problems limiting job function in the month prior to being surveyed. The Cepstral-Spectral Index of Dysphonia Mean was abnormal in 95.3% and CAPE-V overall severity score was abnormal in 94%. There was significant improvement in subjective, perceptual, and acoustic voice outcomes as the amount of time since last training cycle (ie, relative voice rest) and as experience as a Drill Instructor increased, however the VHI-10 was the only measure that normalized.
Conclusion and Relevance
There is a very high prevalence of self-reported dysphonia in Drill Instructors, with near-universal prevalence of some degree of objectively and perceptually-rated dysphonia. Nearly half of those surveyed reported that dysphonia limited their job performance. Relative voice rest and experience seem to mitigate severity, but normal ratings were rare. While objective and perceptually-rated dysphonia are persistent and highly prevalent, it does not necessarily translate into a perceived impairment in this population. For these reasons and considering the importance of extraordinary vocal function in this occupation, Drill Instructors appear to be in dire need of proper voice care to both maximize job performance and mitigate long-term voice-related problems.
Journal of Voice
Abstract
Objective
The purpose of the present study was to translate and validate the English version of the Vocal Fatigue Index (VFI) in to Malayalam language.
Methods
The English version of the VFI was translated into Malayalam language using parallel back translation. The translated version was content validated by three qualified Speech Language Pathologists. The final Malayalam version of the VFI was administered on 528 primary school teachers with and without self-reporting of voice problems. The internal consistency and test-retest reliability were determined using Cronbach's alpha and intraclass correlation coefficients. Independent sample t test was used to assess the difference in means. Receiver operating characteristic curves with sensitivity and specificity were calculated to set cut-off scores for three domains of Malayalam VFI.
Results
The results revealed that the Malayalam version of VFI has an excellent internal consistency across all the three factors of VFI; tiredness of voice and avoidance of voice use (α = 0.922), physical discomfort symptoms (α = 0.923), and improvement of symptoms with voice rest (α = 0.925). Independent sample t test revealed a significant difference (P ≤ 0.001) for total scores of three domains [tiredness and avoidance of voice use (factor 1), physical discomfort symptoms (factor 2), improvement in symptoms with voice rest (factor 3)] between teachers reporting voice problems and teachers not reporting voice problems. Cut-off scores for three different domains of the Malayalam VFI were set at ≥ 16.5 (80% sensitivity and 71.4% specificity) for factor 1, ≥ 6.5 (71.1% sensitivity and 70.1% specificity) for factor 2 and ≤ 7.5 (71.1% sensitivity and 69.9% specificity) for factor 3.
Conclusion
The Malayalam VFI was found to have good internal consistency and reliability. Hence, it can be considered as a valid and reliable tool for identifying vocal fatigue symptoms and its severity among the Malayalam speaking community who report voice disorders.
Journal of Voice
Abstract
Purpose
Several perceptual scales have been developed to assess voice quality in dysphonic voices, among which the Grade Roughness Breathiness Asthenia Strain and a Rate of Dysphonia scale is probably the most frequently used. However, this clinical tool has not been properly validated with a normophonic population yet. The aim of the present study was to provide a first set of reference data gathered from a normal population, to serve as a basis of comparison for vocologists and laryngologists working with French-speaking patients. A second goal was to investigate the influence on this normal voice dataset, of variables known to affect perceptual judgments of pathological voice.
Material and methods
Sustained vowels and sentences produced by 80 healthy, normophonic French native speakers were perceptually assessed by a panel of 18 raters (nine students, nine experts) using the Grade Roughness Breathiness Asthenia Strain and a Rate of Dysphonia scale.
Results
The average overall grade was close to 1 on the (0 to 3) scale, questioning the notion of "normal" voice as opposed to dysphonic voice. Rating reliability as well as perceptual scores were affected by task-, speaker-, and listener-related factors: speech stimuli led to better rating reliability and were judged less severely than voice stimuli; experts were slightly more reliable and less severe than students; older speakers were unanimously considered as more dysphonic. Multiple interactions between these factors were observed, confirming the multidimensional nature of voice quality.
Journal of Voice
Summary
Objective
To determine whether Eulerian Video Magnification software is useful in diagnosis of muscle tension dysphonia (MTD).
Study Design
Prospective.
Methods
Adult patients scheduled in a tertiary care laryngology practice for evaluation of dysphonia were recruited between November 2016 and March 2017. Demographic and clinical data were extracted from patient charts. Diagnosis of MTD was confirmed with videostroboscopic and physical exam and by a speech-language pathologist. Eighteen MTD patients were video recorded while at rest and with phonation. Five patients without MTD also were analyzed as controls. Videos were analyzed using Eulerian Video Magnification software (Massachusetts Institute of Technology) to assess change in blood flow at the forehead, infrahyoid muscles, and sternocleidomastoid muscles, while using the values of the background wall as a control value.
Results
Patients with MTD demonstrated little change in perfusion to the infrahyoid muscles of the neck while phonating (+1% ± 55%). Control subjects demonstrated an increase in perfusion to the infrahyoid muscles while phonating (+102% ± 164%), with this change being significant when comparing the two groups (P = 0.04, t = 2.189, df = 21). A change in perfusion of 0% or less to infrahyoid muscles was 75% sensitive and 70% specific for diagnosis of MTD. No differences in perfusion were found between other regions assessed. Patient age and gender did not correlate with any change in perfusion between rest and phonation.
Conclusion
Our data suggest that Eulerian Video Magnification can be used in the diagnosis of MTD by focusing on the difference in perfusion to the infrahyoid muscles between rest and phonation.
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