Relationships Across Clinical Measures of Vocal Quality and Functioning and Their Relationship With Patient Perception
Publication: American Journal of Speech-Language Pathology
Volume 30, Number 6
Pages 2668-2680
Abstract
Purpose
The purpose of this study was to investigate the relationships among subjective auditory-perceptual ratings of vocal quality, objective acoustic and aerodynamic measures of vocal function, and patient-perceived severity of their vocal complaint.
Method
This study was a retrospective chart review of adult patients evaluated at a single outpatient center over a 1.5-year time period. Twenty-two clinical objective and subjective measures of voice were extracted from 676 charts (310 males, 366 females). To identify the underlying concepts addressed in an initial voice assessment, principal component analyses were conducted for males and females to account for sex differences. Linear regression models were conducted to examine the relationship between the principal components and patient perceived severity.
Results
Seven principal components were identified for both sexes and accounted for 75% and 71% of the variance in the clinical measures, respectively. Of these seven principal components, only two predicted male patient perceived severity, which accounted for 22% of the variance. In contrast, four principal components predicted female patient perceived severity of their voice disorder and accounted for 19% of the variance.
Conclusions
The results highlight the underlying aspects of vocal quality and functioning that are evaluated during an initial assessment. Male and female patients differ in which of these components may contribute self-perceived severity of a voice disorder. Identifying these underlying components may support clinical decision making when developing a clinical protocol and highlights the overlap between patient concerns and clinical measures.
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References
American Speech-Language-Hearing Association. (2019). Voice disorders: Comprehensive assessment. https://www.asha.org/practice-portal/clinical-topics/voice-disorders/#collapse_5
Awan, S. N., Roy, N., Jetté, M. E., Meltzner, G. S., & Hillman, R. E. (2010). Quantifying dysphonia severity using a spectral/cepstral-based acoustic index: Comparisons with auditory-perceptual judgements from the CAPE-V. Clinical Linguistics & Phonetics, 24(9), 742–758.
Awan, S. N., Roy, N., Zhang, D., & Cohen, S. M. (2016). Validation of the Cepstral Spectral Index of Dysphonia (CSID) as a screening tool for voice disorders: Development of clinical cutoff scores. Journal of Voice, 30(2), 130–144.
Behrman, A. (2005). Common practices of voice therapists in the evaluation of patients. Journal of Voice, 19(3), 454–469.
Behrman, A., Agresti, C. J., Blumstein, E., & Sharma, G. (1996). Meaningful features of voice range profiles from patients with organic vocal fold pathology: A preliminary study. Journal of Voice, 10(3), 269–283.
Bhuta, T., Patrick, L., & Garnett, J. D. (2004). Perceptual evaluation of voice quality and its correlation with acoustic measurements. Journal of Voice, 18(3), 299–304.
Branski, R. C., Cukier-Blaj, S., Pusic, A., Cano, S. J., Klassen, A., Mener, D., Patel, S., & Kraus, D. H. (2010). Measuring quality of life in dysphonic patients: A systematic review of content development in patient-reported outcomes measures. Journal of Voice, 24(2), 193–198.
Brinca, L. F., Batista, A. P., Tavares, A. I., Goncalves, I. C., & Moreno, M. L. (2014). Use of cepstral analyses for differentiating normal from dysphonic voices: A comparative study of connected speech versus sustained vowel in European Portuguese female speakers. Journal of Voice, 28(3), 282–286.
Brown, W. S., Jr., Morris, R. J., Hicks, D. M., & Howell, E. (1993). Phonational profiles of female professional singers and nonsingers. Journal of Voice, 7(3), 219–226.
Cantarella, G., Baracca, G., Pignataro, L., & Forti, S. (2011). Assessment of dysphonia due to benign vocal fold lesions by acoustic and aerodynamic indices: A multivariate analysis. Logopedics Phoniatrics Vocology, 36(1), 21–27.
Chaves, C. R., Campbell, M., & Cortes Gama, A. C. (2017). The influence of native language on auditory-perceptual evaluation of vocal samples completed by Brazilian and Canadian SLPs. Journal of Voice, 31(2), 258.e1–258.e5.
Colton, R. H., & Hollien, H. (1972). Phonational range in the modal and falsetto registers. Journal of Speech and Hearing Research, 15(4), 708–713.
Cronbach, L. J. (1951). Coefficient alpha and the internal structure of tests. Psychometrika, 16(3), 297–334.
Dastolfo, C., Gartner-Schmidt, J., Yu, L., Carnes, O., & Gillespie, A. I. (2016). Aerodynamic outcomes of four common voice disorders: Moving Toward disorder-specific assessment. Journal of Voice, 30(3), 301–307.
Dejonckere, P. H., & Lebacq, J. (1996). Acoustic, perceptual, aerodynamic and anatomical correlations in voice pathology. ORL, 58(6), 326–332.
Eadie, T. L., & Doyle, P. C. (2005). Classification of dysphonic voice: Acoustic and auditory-perceptual measures. Journal of Voice, 19(1), 1–14.
Eadie, T. L., Kapsner, M., Rosenzweig, J., Waugh, P., Hillel, A., & Merati, A. (2010). The role of experience on judgments of dysphonia. Journal of Voice, 24(5), 564–573.
Eadie, T. L., Sroka, A., Wright, D. R., & Merati, A. (2011). Does knowledge of medical diagnosis bias auditory-perceptual judgments of dysphonia? Journal of Voice, 25(4), 420–429.
Freitas, S. V., Pestana, P. M., Almeida, V., & Ferreira, A. (2015). Integrating voice evaluation: Correlation between acoustic and audio-perceptual measures. Journal of Voice, 29(3), 390.e1–390.e7.
Ghio, A., Cantarella, G., Weisz, F., Robert, D., Woisard, V., Fussi, F., Giovanni, A., & Baracca, G. (2015). Is the perception of dysphonia severity language-dependent? A comparison of French and Italian voice assessments. Logopedics, Phoniatrics, Vocology, 40(1), 36–43.
Gillespie, A. I., Dastolfo, C., Magid, N., & Gartner-Schmidt, J. (2014). Acoustic analysis of four common voice diagnoses: Moving toward disorder-specific assessment. Journal of Voice, 28(5), 582–588.
Gillespie, A. I., Gooding, W., Rosen, C., & Gartner-Schmidt, J. (2014). Correlation of VHI-10 to voice laboratory measurements across five common voice disorders. Journal of Voice, 28(4), 440–448.
Guimaraes, I., & Abberton, E. (2005). Fundamental frequency in speakers of Portuguese for different voice samples. Journal of Voice, 19(4), 592–606.
Heman-Ackah, Y. D., Sataloff, R. T., Laureyns, G., Lurie, D., Michael, D. D., Heuer, R., Rubin, A., Eller, R., Chandran, S., Abaza, M., Lyons, K., Divi, V., Lott, J., Johnson, J., & Hillenbrand, J. (2014). Quantifying the cepstral peak prominence, a measure of dysphonia. Journal of Voice, 28(6), 783–788.
Hillenbrand, J., & Houde, R. A. (1996). Acoustic correlates of breathy vocal quality: Dysphonic voices and continuous speech. Journal of Speech, Language, and Hearing Research, 39(2), 311–321.
Hirano, M. (1981). Clinical examination of voice. Springer.
Hirano, M. (1983). Growth, development and aging of human vocal folds. In D. M. Bless, & J. H. Abbs (Eds.), Vocal fold physiology, (pp. 22–43). College-Hill Press.
Hunter, E. J., Tanner, K., & Smith, M. E. (2011). Gender differences affecting vocal health of women in vocally demanding careers. Logopedics, Phoniatrics, Vocology, 36(3), 128–136.
Kahane, J. C. (1982). Growth of the human prepubertal and pubertal larynx. Journal of Speech and Hearing Research, 25(3), 446–455.
Kaiser, H. F. (1960). The application of electronic computers to factor analysis. Educational and Psychological Measurement, 20(1), 141–151.
Karlsen, T., Sandvik, L., Heimdal, J. H., & Aarstad, H. J. (2020). Acoustic voice analysis and maximum phonation time in relation to voice handicap index score and larynx disease. Journal of Voice, 34(1), 161.e27–161.e35.
Kempster, G. B., Gerratt, B. R., Abbott, K. V., Barkmeier-Kraemer, J., & Hillman, R. E. (2009). Consensus Auditory-Perceptual Evaluation of Voice: Development of a standardized clinical protocol. American Journal of Speech-Language Pathology, 18(2), 124–132.
Kreiman, J., Gerratt, B. R., & Ito, M. (2007). When and why listeners disagree in voice quality assessment tasks. The Journal of the Acoustical Society of America, 122(4), 2354–2364.
Kreiman, J., Gerratt, B. R., Kempster, G. B., Erman, A., & Berke, G. S. (1993). Perceptual evaluation of voice quality: Review, tutorial, and a framework for future research. Journal of Speech and Hearing Research, 36(1), 21–40.
Kreiman, J., Gerratt, B. R., Precoda, K., & Berke, G. S. (1992). Individual differences in voice quality perception. Journal of Speech and Hearing Research, 35(3), 512–520.
Ladefoged, P., & McKinney, N. P. (1963). Loudness, sound pressure, and subglottal pressure in speech. The Journal of the Acoustical Society of America, 35(4), 454–460.
Lopes, L. W., da Silva, H. F., Evangelista, D. D. S., da Silva, J. D., Simoes, L. B., Silva, P. O. C. E., de Lima-Silva, M. F. B., & de Almeida, A. A. F. (2016). Relationship between vocal symptoms, severity of voice disorders, and laryngeal diagnosis in patients with voice disorders. CODAS, 28(4), 439–445.
Lopes, L. W., da Silva, J. D., Simoes, L. B., Evangelista, D. D. S., Silva, P. O. C., Almeida, A. A., & de Lima-Silva, M. F. B. (2017). Relationship between acoustic measurements and self-evaluation in patients with voice disorders. Journal of Voice, 31(1), 119.e1–119.e10.
Martins, R. H. G., do Amaral, H. A., Tavares, E. L. M., Martins, M. G., Gonçalves, T. M., & Dias, N. H. (2016). Voice disorders: Etiology and diagnosis. Journal of Voice, 30(6), 761.e1.
Maryn, Y., De Bodt, M., & Roy, N. (2010). The acoustic voice quality index: Toward improved treatment outcomes assessment in voice disorders. Journal of Communication Disorders, 43(3), 161–174.
Meyers, L. S., Gamst, G., & Guarino, A. J. (2013). Applied multivariate research: Design and interpretation (2nd ed.). SAGE.
Morris, R. J., Brown, W. S., Jr., Hicks, D. M., & Howell, E. (1995). Phonational profiles of male trained singers and nonsingers. Journal of Voice, 9(2), 142–148.
Murry, T. (1978). Speaking fundamental frequency characteristics associated with voice pathologies. Journal of Speech and Hearing Disorders, 43(3), 374–379.
Murton, O., Hillman, R., & Mehta, D. (2020). Cepstral peak prominence values for clinical voice evaluation. American Journal of Speech-Language Pathology, 29(3), 1596–1607.
Nemr, K., Simoes-Zenari, M., Cordeiro, G. F., Tsuji, D., Ogawa, A. I., Ubrig, M. T., & Menezes, M. H. M. (2012). GRBAS and Cape-V scales: High reliability and consensus when applied at different times. Journal of Voice, 26(6), 812.e17–812.e22.
Patel, R. R., Awan, S. N., Barkmeier-Kraemer, J., Courey, M., Deliyski, D., Eadie, T., Paul, D., Svec, J. G., & Hillman, R. (2018). Recommended protocols for instrumental assessment of voice: American Speech-Language-Hearing Association expert panel to develop a protocol for instrumental assessment of vocal function. American Journal of Speech-Language Pathology, 27(3), 887–905.
Peterson, E. A., Roy, N., Awan, S. N., Merrill, R. M., Banks, R., & Tanner, K. (2013). Toward validation of the cepstral spectral index of dysphonia (CSID) as an objective treatment outcomes measure. Journal of Voice, 27(4), 401–410.
Revelle, W. R. (2018). Psych: Procedures for personality and psychology research (Version R package version 1.8.12). Northwestern University. https://CRAN.R-project.org/package=psych
Rosen, C. A., Lee, A. S., Osborne, J., Zullo, T., & Murry, T. (2004). Development and validation of the voice handicap index-10. The Laryngoscope, 114(9), 1549–1556.
Roy, N., Barkmeier-Kraemer, J., Eadie, T., Sivasankar, M. P., Mehta, D., Paul, D., & Hillman, R. (2013). Evidence-based clinical voice assessment: A systematic review. American Journal of Speech-Language Pathology, 22(2), 212–226.
Roy, N., Merrill, R. M., Gray, S. D., & Smith, E. M. (2005). Voice disorders in the general population: Prevalence, risk factors, and occupational impact. Laryngoscope, 115(11), 1988–1995.
RStudio_Team. (2020). RStudio: Integrated development for R. http://www.rstudio.com/
Saldanha, J. C., Ananthakrishna, T., & Pinto, R. (2013). Vocal fold pathology assessment using PCA and LDA. 2013 International Conference on Intelligent Systems and Signal Processing [ISSP] (pp. 140–144).
Schutte, H. K. (1986). Aerodynamics of phonation. Acta Oto-Rhino-Laryngologica Belgica, 40(2), 344–357. https://www.ncbi.nlm.nih.gov/pubmed/3751529
Sodersten, M., & Lindestad, P. A. (1990). Glottal closure and perceived breathiness during phonation in normally speaking subjects. Journal of Speech and Hearing Research, 33(3), 601–611.
Sofranko, J. L., & Prosek, R. A. (2014). The effect of levels and types of experience on judgment of synthesized voice quality. Journal of Voice, 28(1), 24–35.
Tanaka, S., & Gould, W. J. (1983). Relationships between vocal intensity and noninvasively obtained aerodynamic parameters in normal subjects. The Journal of the Acoustical Society of America, 73(4), 1316–1321.
Tanaka, S., & Gould, W. J. (1985). Vocal efficiency and aerodynamic aspects in voice disorders. Annals of Otology, Rhinology & Laryngology, 94(1), 29–33.
Tanaka, S., & Tanabe, M. (1986). Glottal adjustment for regulating vocal intensity. An experimental study. Acta Oto-Laryngologica, 102(3–4), 315–324.
Titze, I. R. (1989). Physiologic and acoustic differences between male and female voices. The Journal of the Acoustical Society of America, 85(4), 1699–1707.
Watts, C. R., & Awan, S. N. (2011). Use of spectral/cepstral analyses for differentiating normal from hypofunctional voices in sustained vowel and continuous speech contexts. Journal of Speech, Language, and Hearing Research, 54(6), 1525–1537.
Weinberg, S. L., & Abramowitz, S. K. (2016). Statistics using Stata: An integrative approach. Cambridge University Press.
World Health Organization. (2001). International classification of functioning, disability and health.
Wuyts, F. L., De Bodt, M. S., Molenberghs, G., Remacle, M., Heylen, L., Millet, B., Van Lierde, K., Raes, J., & Van de Heyning, P. H. (2000). The dysphonia severity index: An objective measure of vocal quality based on a multiparameter approach. Journal of Speech, Language, and Hearing Research, 43(3), 796–809.
Yiu, E. M. L., Murdoch, B., Hird, K., Lau, P., & Ho, E. M. (2008). Cultural and language differences in voice quality perception: A preliminary investigation using synthesized signals. Folia Phoniatrica et Logopaedica, 60(3), 107–119.
Zraick, R. I., Smith-Olinde, L., & Shotts, L. L. (2012). Adult normative data for the KayPENTAX phonatory aerodynamic system model 6600. Journal of Voice, 26(2), 164–176.
Information & Authors
Information
Published In
American Journal of Speech-Language Pathology
Volume 30 • Number 6 • 4 November 2021
Pages: 2668-2680
PubMed: 34723650
Copyright
Copyright © 2021 American Speech-Language-Hearing Association.
History
- Received: May 4, 2021
- Revised: Jul 17, 2021
- Accepted: Jul 26, 2021
- Published online: Nov 1, 2021
- Published in issue: Nov 4, 2021
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- Yolanda Holt, Reflecting on the Role of Gender and Race in Speech-Language Pathology, Perspectives of the ASHA Special Interest Groups, 10.1044/2022_PERSP-22-00019, 7, 6, (2158-2168), (2022).
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