Applying the Voice Handicap Index (VHI) to Dysphonic and Nondysphonic Hebrew Speakers

OBJECTIVE: To evaluate a translated version of the Voice Handicap Index (VHI) as a diagnostic tool for people with and without a laryngeal pathology, among Hebrew speakers. STUDY DESIGN: Parallel group design. METHODS: The VHI was translated and adapted to Hebrew. The translated version was, then, administered to a group of 182 patients with various laryngeal pathologies and a control group of 171 people with no laryngeal pathology. Based on the participants' responses to the VHI, statistical analyses were, initially, performed to assess validity and reliability, and then to evaluate group differences between the pathological and control groups and among the different pathological groups included in the study. RESULTS: Statistical analyses showed high reliability values of the Hebrew version of the VHI (overall Cronbach's alpha r = 0.976). Participants' scores were not affected by their age (P = 0.156) or gender (P = 0.261). The participants in the control group obtained significantly lower scores on the overall VHI score, as well as on all three subscale scores, in comparison with the pathological group (P < 0.001). In addition, within the pathological group, patients with neurogenic pathologies received higher scores than all other pathological groups, whereas patients with laryngeal inflammation received lower scores than all other pathological groups (P < 0.05). CONCLUSION: The VHI is a powerful tool for quantifying patients' perceptions of their voice handicaps, and it maintained its power across translation. The VHI was shown to be valuable for the assessment of speakers with, as well as without laryngeal pathologies.     

Reliability of Clinician-Based (GRBAS and CAPE-V) and Patient-Based (V-RQOL and IPVI) Documentation of Voice Disorders

This study examined the reliability of two methods for documenting voice quality by clinicians and compared the methods for documenting patients' perceptions of voice quality. It involved a prospective reliability study and a retrospective chart review. Reliability of two clinician-based voice assessment protocols-Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS) and Consensus Auditory Perceptual Evaluation-Voice (CAPE-V)-was evaluated. These two protocols were then compared after use in voice assessments of 42 males and 61 females performed by a certified speech-language pathologist specializing in the assessment of voice disorders. In addition, two patient-based scales (Voice Related Quality of Life, or V-RQOL, and Iowa Patient's Voice Index, or IPVI) obtained from the same patients were compared with each other and with the clinician-based scales. Reliability of clinicians' ratings of overall severity of dysphonia using GRBAS and CAPE-V scales was very good (r>0.80). Agreement between V-RQOL Total scores and IPVI ratings of the patient's perceptions of impact of dysphonia was less strong (Spearman's r=-0.76). There was relatively weak agreement between patient-based and clinician-based scales. Clinician's perceptions of dysphonia appeared to be reliable and unaffected by rating tool, as indicated by the high level of agreement between the two rating systems when they were used together. The CAPE-V system appeared to be more sensitive to small differences within and among patients than the GRBAS system. The V-RQOL and IPVI approaches to documenting patient's perceptions of dysphonia agreed less well possibly due to differences in patient dependence on voice and on interpretation of the rating tool items. The differences between clinician-based and patient-based data support the conclusion that clinicians and patients experience and consider dysphonia very differently.     

Suitability of minidisc (MD) recordingsfor voice perturbation analysis

A new digital recording format, Minidisc (MD), shows promise for high-quality voice recordings. It is available in a portable size and uses magneto-optical recording techniques on a miniature compact disc. The disc can be recorded an unlimited number of times with essentially the same playback life span; however, the digital recording technique uses a data compression algorithm that may interfere with acoustic voice perturbation analysis. This study investigated what effects this compression may have and whether the MD format is viable for use in this application.The MD format was evaluated by traditional synthetic test signals used onrecording devices. In addition, human phonation recorded on Digital Audio Tape (DAT) was used as the input to the MD. The output of the MD was then compared to the original DAT recording. The two signals were analyzed for long- and short-term perturbation measures, and their waveforms were visually inspected. The results indicated that the MD format performed as well as the DAT format in all areas of standard tests, with the exception of signal-to-noise (S/N) ratio. S/N ratio for the MD was approximately 10 dB less than for the DAT under normal operating conditions; however, in comparing perturbation measures on normal human vowels, there were no significant differences between the two formats, i.e., no distortions in voice perturbation were introduced by the MD record/playback process.     

Correlation of the Voice Handicap Index (VHI) and the Voice-Related Quality of Life Measure (V-RQOL)

The purpose of this study was to investigate the correlation between the Voice Handicap Index (VHI) and the Voice-Related Quality of Life Measure (V-RQOL), and to test conversion of scores between the two instruments. Understanding the relationship between instruments will facilitate comparison of voice outcome studies using different measures. A retrospective medical chart review of 140 consecutive patients with a chief complaint related to their voice presenting for speech pathology voice evaluation following laryngology evaluation and diagnosis was adopted. Each patient who filled out the VHI and V-RQOL within a 2-week period with no intervening treatment was included in the study. Correlation analysis for total scores was performed for the patients meeting inclusion criteria (n=132). Correlations were also performed as a function of diagnosis. Calculated VHI score based on measured V-RQOL score was compared to measured VHI score. Pearson correlation between scores on the VHI and V-RQOL was -0.82. There was no significant difference between the mean measured and mean calculated VHI scores. For individual scores, however, regression analysis did reveal a significant difference between calculated and measured VHI. The VHI and V-RQOL are highly correlated; however, this study suggests that the two instruments are not interchangeable for individuals.     

Common Practices of Voice Therapists in the Evaluation of Patients

This study surveys voice therapists regarding common diagnostic practices in patients referred for therapy with the diagnosis of muscle tension dysphonia (broadly defined as the "hyperfunctional" component of the dysphonia). Through postings on the e-mail list of the ASHA special interest division on voice, speech pathologists with at least 3 years' experience in stroboscopy and acoustic instrumentation were invited to complete the survey. Results from 53 completed surveys demonstrated that voice quality and patient self-perception are the sole assessments performed by all therapists. Voice quality, observation of body posture and movement, and probing the patient's ability to alter voice production are each significantly more likely to be performed than the more objective stroboscopic, acoustic, aerodynamic, and EGG assessments. Further, the tasks of defining specific therapy session goals and helping the patient to achieve a particular target skill are considered best served by measures of vocal quality, observation of body position and movement, and judging the patient's ability to alter voice production. For definition of the overall therapy goal, stroboscopy and patient perception scales are added to all of the subjective assessment measures as being important. Acoustic data are considered most important for patient reinforcement and outcomes assessment. Implications of these findings are discussed, and topics for further exploration are identified.     

Expert consensus in solo voice performance evaluation

Experts were interviewed to identify criteria for evaluation of vocal performance. A scale was then constructed and inter- and intrajudge reliability assessed. Experts listened to 19 different performances, plus 6 presented a second time. Interjudge reliability for one judge was modest, but increased dramatically as the size of the judge panel increased. The most reliable items were overall score and intonation accuracy. Diction was less reliable than other items. Intrajudge reliability was higher for overall score than for any other item. A factor analysis on the test items yielded factors labelled intrinsic quality, execution, and diction. Another factor analysis, using the experts as variables, revealed two underlying evaluative dimensions. It was found that 13 experts were primarily influenced by execution, and that 8 were mainly affected by intrinsic quality. Interjudge and intrajudge reliabilities of these two groups differed.     

Contemporary Commercial Music (CCM) Survey: Who''s Teaching What in Nonclassical Music

Currently, there is an increasing interest in and demand for training in a wide variety of nonclassical music--contemporary commercial music (CCM)--and most particularly for music theater. A survey of singing teachers was completed to elucidate their training, education, and experience with and methods of teaching CCM. Teachers were at colleges, universities, and conservatories as well as in private studios, both nationally and in several foreign countries. A substantial percentage of those teaching CCM had neither formal education in teaching it nor professional experience. Many of the respondents indicated conflict between classical and CCM styles. Respondents were generally familiar with voice science and voice medicine as well as certain CCM terminology. Teachers expressed an interest in obtaining more information, with an emphasis on healthy vocal production. These results are discussed, as well as implications for the singing teacher who desires specific training to teach CCM.     

The effect of task on determination of habitual loudness

The purpose of this study was to investigate if there is an effect of task on determination of habitual loudness. Four tasks commonly used to elicit habitual loudness were compared (automatic speech, elicited speech, spontaneous speech, and reading aloud). Participants were adult female speakers (N=30) with normal voice. A one-way analysis of variance (ANOVA) revealed a statistically significant (p < 0.05) effect of task, with post-hoc analyses indicating that there was a statistically significant difference in habitual loudness elicited via automatic versus spontaneous speech (p < 0.05), and automatic speech versus reading aloud (p < 0.001). The issue of how habitual loudness is defined is considered. Implications of the use of one task for determination of habitual loudness are discussed, as is the possibility of a task effect on determination of other clinically useful vocal parameters.