Emergence of "Voice specialty clinics" in ENT and Speech Language Pathologist (SLP) practice in India necessitates development of standard protocols for assessment and management of voice disorders. Based on recommendations from European Laryngological Society in Dejonckere (Eur Arch Otorhinolaryngol 258:77-82, 2001), a comprehensive voice assessment protocol was adapted for Indian population. This study aimed at verifying the face validity and feasibility of using the developed voice assessment protocol in a multi specialty tertiary care hospital. It included: history, clinical examination, visual analysis, perceptual analysis, aerodynamic measures, acoustic analysis and patients' self assessment of voice. The developed protocol was administered on 200 patients with voice concerns and problems. Correlation of self assessment with the assessment by the professionals was done using Kendaul tau_b correlation test. The scores of self assessment did not correlate significantly with acoustic measures. Differences in lab findings and self percept of voice indicated that these two were complementary measures in the protocol. Further, diagnosis and management decisions were arrived through a consensus discussion involving the ENT surgeon, SLP and the patient. Vocal hygiene and voice conservation were advised to all patients. Recommendations for voice therapy and/or surgery were provided based on findings from the protocol. The study demonstrated feasibility of using a comprehensive protocol for effective documentation, comparisons, review, training and treatment planning.

4. Laryngoscope, 126:2305-2309, 2016.

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Introduction: Voice overuse may result in roughness, fatigue and pain while speaking. Vocal loading tasks have been used to assess changes in voice quality under different controlled settings. This study was done to document changes in voice characteristics before, immediately and 24 hours post-vocal loading task (VLT) using stroboscopic and acoustic analysis.Materials and methods: Ten healthy adult males (age range: 20 to 40 years) with no apparent comorbid illness participated in the study. They were instructed to read the standard Rainbow passage at intensity above 75 dB SPL until they perceived any symptoms of fatigue/ strain. Stroboscopy and comprehensive voice assessment were done on all subjects before, immediate post VLT and 24 hours post VLT.Results: Symptoms of vocal fatigue were noted on an average of 45 minutes of loud reading. Vocal fold edema, ventricular band hyperadduction and arytenoid congestion were noticed in immediate post task. The vocal fold movements were asymmetric and aperiodic with reduced mucosal wave and amplitude. Maximum phonation time (MPT) revealed statistically significant decrease (approximately 7 sec). Multiparametric acoustic analysis revealed a statistically significant increase in fundamental frequency, perturbation measures and lowest intensity with significant decrease in dysphonia severity index (DSI). All parameters (stroboscopic findings, perceptual, aerodynamic and acoustic analysis) showed values within normal limits after 24 hours post-task indicating recovery at 24 hours after vocal loading. Stroboscopy served as an evidence for structural and functional changes in the vocal fold. Changes in voice characteristics and recovery following vocal loading task can be documented using comprehensive voice assessment.