What Determines the Differences in Perceptual Rating of Dysphonia between Experienced Raters?

Abstract

Although the perceptual GRBAS scale for pathological voice quality has been found to be sufficiently reliable in clinical practice, even experienced raters disagree to some extent, and the degree of disagreement depends on the perceptual characteristics. We looked for a possible link between the degree of disagreement (65 voices; 2 experienced raters) and objective acoustical measurements. No significant correlation appeared between any acoustical parameter and the degree of disagreement for G. By contrast, the difference in perceptual rating of R was related to the amount of shimmer, and the difference in perceptual rating of B was related to some extent to the amount of jitter. Thus the presence of a strong breathy component in a pathological voice disturbs the rating of the rough component, and reciprocally.

Reliability of perceptions of voice quality: evidence from a problem asthma clinic population

“…More commonly, grade is used as a measure of overall severity and has been generally reported as showing the best levels of agreement. 13,19,21,22 By comparison, in the current study the raters achieved a rather modest 64.7 per cent for inter-rater reliability and 69.6 per cent for intra-rater reliability for the grade item score. When one considers the asthenicity scale item, inter-and intra-reliability scores dropped as low as 43.4 and 49.6 per cent, respectively, a tendency that is repeated in other studies for the categories of both asthenicity and strain, usually, however, to the greater detriment of strain.…”

“…12,18 -22 Other authors have employed the scale, fully or partially, as a ratings tool, and have incidentally reported on rater reliability. 23,24 The raters employed in such studies have varied in number from two 13,18,22 to 28. 25 Some raters have been specially 'trained' in use of the scale, 26 while others have been more or less experienced in the field of clinical voice management, being variously patients, 25 students, 24 speech and language therapists and pathologists, 12,23,25,27 and ENT surgeons and phoniatricians.…”

Reliability and Validity of the Italian Version of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V)

“…Further studies, including pathological voices of different etiologies and a larger number of raters exploring the effect of the raters' experience and education, are needed to further validate the CAPE-V because previous research on perceptual voice assessment indicates that all of these parameters play a significant role in its reliability [24,26,27,28,29]. …”

Correlates of Varying Vocal Fold Adduction Deficiencies in Perception and Production: Methodological and Practical Considerations

“…Millet and Dejonckere [9] define roughness as 'the voice quality related to [the] impression of irregular glottal pulses'. Wolfe et al [4] found that frequency perturbation measures are more important in the evaluation of roughness than amplitude perturbation measures, while they quote other findings showing that the noise-to-harmonic ratio is the main predictor of roughness [25,26].…”

“…The role of audible friction for predicting breathiness is also supported by our data, although Spectral Energy parameters (especially NHR and VTI) do not predict the breathiness scores for all raters. In fact, the breathiness scores are mainly predicted by Frequency Perturbation measures (particularly PPQ) [9]. Although the term 'inefficient' in the quotation from Laver [27] above is probably not meant to indicate unstable vocal fold vibration and probably refers to the large volume of the unmodulated airflow, a lack of adduction leads to poorer phonation conditions, which can also lead to irregular vocal fold vibration reflected in stronger frequency perturbations.…”