In recent years, the multiparametric approach for evaluating perceptual rating of voice quality has been advocated. This study evaluates the accuracy of predicting perceived overall severity of voice quality with a minimal set of aerodynamic, voice range profile (phonetogram), and acoustic perturbation measures. One hundred and twelve dysphonic persons (93 women and 19 men) with laryngeal pathologies and 41 normal controls (35 women and six men) with normal voices participated in this study. Perceptual severity judgement was carried out by four listeners rating the G (overall grade) parameter of the GRBAS scale. The minimal set of instrumental measures was selected based on the ability of the measure to discriminate between dysphonic and normal voices, and to attain at least a moderate correlation with perceived overall severity. Results indicated that perceived overall severity was best described by maximum phonation time of sustained /a/, peak intraoral pressure of the consonant-vowel /pi/ strings production, voice range profile area, and acoustic jitter. Direct-entry discriminant function analysis revealed that these four voice measures in combination correctly predicted 67.3% of perceived overall severity levels.
In speech rehabilitation after laryngectomy, QOL and speech intelligibility and acceptability should be considered together to find a balance that is acceptable to the patient.
The aim of the present study was to evaluate the effects of age and gender on selected vocal fold vibratory behaviors during vowel prolongation and connected speech using electroglottography (EGG). Forty-six young and older individuals (23 males and 23 females) with normal voices participated in this study. EGG parameters including fundamental frequency and contact quotient were measured during sustained vowel prolongation and connected speech tasks. Significant age-by-gender interactions were found for both parameters. Moreover, results from discriminant function analyses revealed that the overall accuracies of the parameters in predicting different age and gender groups were higher for the connected speech tasks than for the sustained vowel prolongation task (89.1% and 73.9% for passage and phrase tasks vs 71.7% for vowel prolongation). These findings suggest that reliability of EGG measures can be affected by the test stimuli. Therefore, one should carefully consider the use of the speech material when assessing vocal fold behaviors using EGG. The findings also support the use of connected speech stimulus, preferably at passage level, in electroglottographic evaluation for a better representation of vocal fold vibrating behaviors.
The present study investigated the effects of practice variability on the learning of relaxed phonation using a motor learning perspective. Twenty-one individuals with hyperfunctional voice problems were evenly and randomly assigned to three groups of practice conditions: constant, blocked, and random practice conditions. During training, participants in the constant practice condition were asked to read aloud sentence stimuli with four Chinese characters. Participants in the blocked practice condition were asked to read aloud sentence stimuli with increasing sentence length, starting from sets of two characters to five characters. Participants in the random practice condition were asked to practice reading sentence stimuli of variable length from two to five characters presented in a random fashion. Surface electromyographic feedback (sEMG) from the thyrohyoid muscle site was given to each participant after reading every two sentence stimuli. Results demonstrated that for all the participants, voice motor learning was evidenced by the decreased sEMG levels in delayed retention test. Generalization to untrained passage was shown as well. However, results did not reveal any difference in the learning among the three practice conditions. The findings from the present study did not support the hypothesis of contextual interference, which states that practice using variable items presented in a random mode is more beneficial to learning than practice using constant items.
Traditional clinical voice evaluation focuses primarily on the severity of voice impairment, with little emphasis on the impact of voice disorders on the individual's quality of life. This study reports the development of a 28-item assessment tool that evaluates the perception of voice problem, activity limitation, and participation restriction using the International Classification of Impairments, Disabilities and Handicaps-2 Beta-1 concept (World Health Organization, 1997). The questionnaire was administered to 40 subjects with dysphonia and 40 control subjects with normal voices. Results showed that the dysphonic group reported significantly more severe voice problems, limitation in daily voice activities, and restricted participation in these activities than the control group. The study also showed that the perception of a voice problem by the dysphonic subjects correlated positively with the perception of limitation in voice activities and restricted participation. However, the self-perceived voice problem had little correlation with the degree of voice-quality impairment measured acoustically and perceptually by speech pathologists. The data also showed that the aggregate scores of activity limitation and participation restriction were positively correlated, and the extent of activity limitation and participation restriction was similar in all except the job area. These findings highlight the importance of identifying and quantifying the impact of dysphonia on the individual's quality of life in the clinical management of voice disorders.
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