Multi parametric voice assessment: sri ramachandra university protocol

An Open Access Standardised Voice Evaluation Protocol

PURPOSE

A comprehensive protocol to evaluate voice quality can support a full characterisation of voice disorders and be used to plan voice interventions. The purpose of this study was to develop and validate a standardised protocol for voice assessment, contributing with a comprehensive and valuable tool for clinician practice and research.

METHOD

The initial structure and content of the protocol was based on an extensive literature review of existing voice assessment tools. The content validity was then assessed by a panel of voice specialist, using a modified Bland and Altman graphical method and the intraclass correlation coefficient (ICC). A group of participants with vocal pathology was finally assessed by two voice specialists on the same day (inter-rater reliability), and, on a second day, by a single evaluator (intra-rater reliability). Inter and intra-reliability were evaluated through Cohen's kappa (k) for nominal variables, and Spearman's Correlation Coefficient (ρ) for quantitative and ordinal variables.

RESULTS

The Bland and Altman analysis, revealed a reasonable agreement between the experts and the ICC values were lower than expected, but the confidence intervals were very wide. The intra-rater reliability of the protocol's nominal variables was almost perfect, with a mean k of 0.977; inter-rater reliability of nominal variables was also almost perfect, with a mean k of 0.893. The ordinal and quantitative variables revealed a very good to excellent relationship, with a mean ρ of 0.912.

CONCLUSIONS

Evidence of content validity, high intra and inter-rater reliability of a standardised protocol for voice assessment, have been shown. This protocol can be used to assess and collect data from patients, to train voice specialists and to develop reference voice databases. It has been designed to serve voice experts with diverse backgrounds and assessment needs.

Effect of Anchor Voices and Listener Expertise on Auditory-Perceptual Judgments of Voice Quality Using the GRBAS Scale

OBJECTIVES

This study aimed to determine the effect of anchor voices and listener expertise on auditory-perceptual judgment of voice quality using the GRBAS scale.

METHODS

This study utilized a modified crossover design with counterbalancing. Anchor voices for each parameter of the GRBAS scale were chosen based on expert consensus. A total of 28 participants were divided into three groups based on their expertise. The first and second groups consisted of nine undergraduate (UG) and nine postgraduate (PG) students of speech-language pathology. The third group consisted of 10 practicing speech-language pathologists (SLPs). These participants carried out auditory-perceptual judgment of 60 dysphonic voice samples under two counterbalanced experimental conditions (with and without anchor voices). Each of the three groups was randomly divided into two subgroups to balance the experimental conditions. Interrater reliability for each subgroup was calculated using Krippendorff's α and 95% confidence intervals.

RESULTS

For all the groups involved in the study, interrater reliability was higher when anchor voices aided perceptual judgment for most parameters of the GRBAS scale. For the different parameters of GRBAS, interrater reliability for the UG group varied from fair (20 < α ≤ 40) to moderate (40 < α ≤ 60). In contrast, it was fair (20 < α ≤ 40) to substantial (60 < α ≤ 80) for the PG group and moderate (40 < α ≤ 60) to substantial (60 < α ≤ 80) for the SLP group. Variations in reliability were the least for the SLP group compared to the UG and PG groups. However, there were overlaps in interrater reliability between the groups, as revealed by the 95% confidence intervals.

CONCLUSIONS

Anchor voices help improve the auditory-perceptual judgment of voice quality, especially interrater reliability. Listener expertise is also shown to influence the interrater reliability of auditory-perceptual judgment of voice quality.

Reliability and Correlations Between Overall Severity, Roughness and Breathiness in the Perception of Dysphonic Voices: Investigating Cognitive Aspects

OBJECTIVES

this study concerns the subjective perception of the quality of the voice, more particularly in the case of dysphonia. Our general objective is to study the perceptual mechanisms, which constitute Hirano's GRBAS multidimensional perceptual rating scale.

MATERIAL AND METHODS

We tested the reliability of the GRB perceptual scale both in terms of test-retest reliability (intra-listener stability) and in terms of inter-listener agreement. We also studied how listeners process the three different parameters of the scale by varying the perceptual rating conditions of G, R, and B. The three attributes were rated simultaneously in one condition and in isolation in a second condition. The experiment was based on texts read by fifty dysphonic speakers. We selected five listeners specialized in voice assessment to provide perceptual judgments of the voices.

RESULTS AND CONCLUSIONS

Our results show that G is strongly correlated with R and/or B. When the GRB rating process is simultaneous, G is almost equal to the maximum score assigned to the R and/or B parameter (R² = 0.97). Conversely, R and B are poorly correlated. While intra-listener variability was limited, inter-judge variability was important even in a homogeneous panel of judges.

The Efficacy of the Manual Circumlaryngeal Therapy for Muscle Tension Dysphonia: A Systematic Review and Meta-analysis

OBJECTIVE

Muscle tension dysphonia (MTD) is the most common functional voice disorder. Behavioral voice therapy is the front-line treatment for MTD, and laryngeal manual therapy may be a part of this treatment. The objective of this study was to investigate the effect of manual circumlaryngeal therapy (MCT) on acoustic markers of voice quality (jitter, shimmer, and harmonics-to-noise ratio) and vocal function (fundamental frequency) through a systematic review with meta-analysis.

DATA SOURCES

Four databases were searched from inception to December 2022, and a manual search was performed.

REVIEW METHODS

The PRISMA extension statement for reporting systematic reviews incorporating a meta-analysis of health care interventions was applied, and a random effects model was used for the meta-analyses.

RESULTS

We identified 6 eligible studies from 30 studies (without duplicates). The MCT approach was highly effective on acoustics with large effect sizes (Cohen's d > 0.8). Significant improvements were obtained in jitter in percent (mean difference of -.58; 95% CI -1.00 to 0.16), shimmer in percent (mean difference of -5.66; 95% CI -8.16 to 3.17), and harmonics-to-noise ratio in dB (mean difference of 4.65; 95% CI 1.90-7.41), with the latter two measurements continuing to be significantly improved by MCT when measurement variability is considered.

CONCLUSION

The efficacy of MCT for MTD was confirmed in most clinical studies by assessing jitter, shimmer, and harmonics-to-noise ratio related to voice quality. The effects of MCT on the fundamental frequency changes could not be verified. Further contributions of high-quality randomized control trials are needed to support evidence-based practice in laryngology. Laryngoscope, 134:18-26, 2024.

Measuring Perceived Voice Disorders and Quality of Life among Female University Teaching Faculty

BACKGROUND

Occupations that require heavy vocal use can place the person at risk of voice disorders (VDs). Heavy demands on the voice, especially for a long time or with loud back-ground noise, can lead to vocal abuse or misuse. The study aimed to measure the prevalence of perceived voice disorders among the teaching faculty at a female university, identify the risk fac-tors that affect their voice, and determine the effect of perceived voice disorders on their quality of life (QoL).

METHODS

The study sample consisted of female teaching faculty (N = 401). The ques-tionnaire included general sociodemographic data, general voice data, the vocal tract discomfort (VTD) scale, and the World Health Organization Quality of Life assessment (WHOQOL)-BREF.

RESULTS

The results demonstrated that 44.1% of the participants had perceived voice disorders, and stress, reflux, and asthma had a significant relationship with self-perceived voice disorders. Furthermore, the data showed that self-perceived voice disorders negatively impacted the overall QoL of teaching faculty.

CONCLUSIONS

Perceived voice disorders are affected by various factors, including health conditions, medications, and lifestyle choices. Although teaching characteristics and demo-graphic factors are believed to be the cause, in this study they did not significantly contribute to perceived voice disorders. Faculty members with perceived voice disorders have a poorer quality of life, highlighting the need for education on preventative vocal measures and awareness of voice care.

VoxMore: technological artifact to assist voice acoustic evaluation in the teaching-learning process and clinical practice

PURPOSE

to present a technological artifact, the VoxMore plugin, to assist the academic teaching of voice acoustic assessment, as well as to optimize the speech therapy intervention in the practice of vocal clinics.

METHODS

this is a multidisciplinary methodological study for the development of a technological artifact, a plugin, to be used in the Praat software. This tool performs vocal acoustic analysis and generates a report, with information and images referring to the domains of time, frequency, time-frequency, and que-frequency, as well as values of acoustic measures related to fundamental frequency (f0), period measures, disturbance measures of the period of f0, f0 amplitude perturbation measurements, spectral measurements, glottal noise measurements and cepstral measurements.

RESULTS

in the VoxMore acoustic report, four files are generated with the following information: oscillograms of the voice signal and traces of f0 and intensity; images related to the frequency domain, Fourier spectrum and LPC spectrum, and to the time-frequency domain, spectrogram; information on cepstral and cepstrogram analysis; the values of all acoustic measurements, in numerical results format and in vertical bar graphs.

CONCLUSION

VoxMore can contribute both to the teaching-learning process, acting as an auxiliary tool with a formative character in the undergraduate and graduate courses in Speech-Language Pathology, as well as to the clinical practice process, making the use of acoustic analysis in the vocal clinic feasible and supporting decision-making by speech-language pathologist.

Psychometric Properties of the Voice Handicap Index-10 in Kannada

OBJECTIVES

This study aimed to derive the 10-item voice handicap index in the Kannada language (VHI-K10) from the existing VHI-30 in Kannada (VHI-K30). We also aimed to examine several psychometric properties of the newly derived VHI-K10, such as internal consistency, reliability, concurrent validity, discriminant validity, and diagnostic accuracy.

METHODS

Initially, VHI-K10 was derived from the existing VHI-K30 through item reduction, consistent with the recommendations for item reduction of the voice handicap index. This newly derived VHI-K10 was administered to 273 individuals (199 individuals with dysphonia and 74 individuals with normal voice quality). We also obtained phonation and reading samples from the participants. The obtained data were subjected to appropriate statistical analysis to determine several psychometric properties.

RESULTS

The newly derived VHI-K10 was found to have a strong internal consistency (Cronbach's α = 0.93). We also found strong test-retest reliability for VHI-K10, with an intraclass correlation coefficient of 0.933. There was a strong statistically significant correlation between the VHI-K10 and the existing VHI-K30 for both individuals with dysphonia (ρ = 0.924, P < 0.001) and individuals with normal voice quality (ρ = 0.798, P < 0.001). However, the correlation of VHI-K10 with the auditory-perceptual measure of GRBAS was fair (ρ = 0.353, P < 0.001) for individuals with dysphonia and was not statistically significant for individuals with normal voice quality. Further, the diagnostic accuracy of VHI-K10 was found to be excellent, with an area under the curve (AROC) value of 0.926 with a cut-off point of ≥6.5, which was slightly superior to that of VHI-K30 (AROC = 0.909, cut-off point ≥21.5).

CONCLUSIONS

The shortened 10-item version of the voice handicap index in Kannada is consistent with versions of the VHI-10 in other languages. This version of the VHI-10 in Kannada is found to be a robust tool with strong psychometric properties.

The maximum phonation time as marker for voice treatment efficacy: A network meta-analysis

PURPOSE

There is a diversity in treatment approaches for voice therapy in which aerodynamic treatment effects between the approaches are lacking. The evidence of voice treatments on the maximum phonation time (MPT) was quantified using the statistical approach of a network meta-analysis (NMA).

DATA SOURCES

Three databases and manual search from inception to November 2021 were evaluated.

STUDY SELECTION

Studies were considered which were reports of randomised controlled/clinical trials (RCT) evaluating the efficacy of a specific voice therapy treatment using MPT as an outcome measure in adult participants with voice disorders. Studies were excluded if participants had been diagnosed with neurological-motor-speech disorders or who were vocally healthy. Furthermore, no medical, pharmacological, or technical instrumental treatments were used.

DATA EXTRACTION AND SYNTHESIS

Preferred Reporting Items for systematic reviews and meta-analyses extension statement guidelines were followed. Two reviewers independently screened citations, extracted data, and assessed risk of bias using PEDro scale. Random effects model was used for meta-analysis.

RESULTS

We identified finally 12 RCT studies (treatment groups n = 285, and control group without an intervention n = 62). Eight interventions were evaluated. The only effective intervention with a significant effect was vocal function exercises (VFE) (mean pre-post difference 6.16 s, 95% confidence interval, 1.18-11.13 s).

CONCLUSIONS AND RELEVANCE

VFE effectively improved MPT from pre- to post-treatment in comparison with other voice interventions which were identified in the present NMA. Further high-quality intervention studies with large samples sizes, multidimensional measures, and homogeneous groups of dysphonia are needed to support evidence-based practice in laryngology.

Outcomes of Vocal Hygiene Program in Facilitating Vocal Health in Female School Teachers With Voice Problems

BACKGROUND

Teachers suffer greater impacts of voice problems due inappropriate voice use and other contributing factors such as physiological, environmental, and individual & work related issues. Structured vocal hygiene programs (VHP) prevent/reduce the risk of vocal trauma and promote vocal health in teachers. This study aimed to estimate the outcome of instituting a sociocultural relevant vocal hygiene program in facilitating vocal health among female school teachers using a comprehensive voice assessment protocol.

METHOD

VHP was developed emphasizing adequate hydration, healthy vocal diet, posture and alignment, vocal practices while teaching, and ideal speaking environment. This was administered via a face to face session to seventeen female teachers with voice concerns. All underwent a comprehensive voice assessment (subjective, objective, and self-perceptual vocal measures) before and four weeks after the VHP. Inter-rater reliability for perceptual and visual examination was estimated using Intra-Class Coefficient. Wilcoxon signed ranks test was used to compare the pre- and post-treatment measures of continuous variables (acoustic, Maximum phonation time, s/z ratio, Vocal Fatigue Index [VFI] & Voice Disorder Outcome Profile [V-DOP]), and McNemar test was used for categorical variables (vocal health questionnaire, visual examination of larynx and perceptual evaluation of voice).

RESULTS

Teachers reported reduction of unhealthy vocal & nonvocal practices after VHP. Improvements in vocal and related symptoms such as sensation of heart burn (P = 0.031), discomfort around the throat (P = 0.008), inadequate breath control while speaking (P = 0.016) were noticed. Perceptually, minimal improvement was seen in voice quality (overall grade). However, MPT & s/z ratio showed no significant difference. Improvement was observed in frequency range (P = 0.004), low I₀ (P = 0.044), shimmer (P = 0.017), and DSI (P = 0.013). Changes were evident in all parameters of stroboscopic evaluation (except nonvibratory portion & ventricular fold hyper-adduction). V-DOP scores indicated positive change in the overall severity (P = 0.002), physical (P = 0.003) and functional domain (P = 0.034). VFI indicated improvement in teachers voice after a period of voice rest (P = 0.048).

CONCLUSION

Though VHP facilitated in improving the teachers' awareness of at risk phono-traumatic behaviors and vocal health, its efficiency was limited in producing physiological improvement in teachers' voice. The comparison of vocal metrics before & after the treatment provides information on changes that can be expected in teachers after guiding them through a systematic VHP.

An E-Survey of Current Voice Therapy Practices Amongst Speech Language Pathologists (SLPs) in India

In India, Speech Language Pathologists (SLPs) generally work with ENT surgeons and use a variety of treatment approaches, service delivery methods, feedback modes, and outcome measures in clinical practice while dealing with voice disorders. The practice preferences of the SLPs are based on theoretical and practical exposure during their graduate course, guidance from professional bodies, evidence-based practices, etc. The facilities in the work setting also determine the practice style of the SLP. This study reports information on demographics of the SLPs, nature of patients served, intervention methods, and evidence-based practices followed by the SLPs via an E-survey. Analysis of the survey from 55 SLPs in India, who work in the area of voice revealed that most SLPs had postgraduate (67.27%; n = 37) and doctorate degree (23.63%; n = 13) and worked in medical-related settings (81.81%; n = 45). Therapeutic approaches were practiced as stated in literature by 43.64% (n = 24) of SLPs. Although 56.36% (n = 31) of SLPs modified therapeutic approaches based on the client's needs (75%), literacy (16.66%) and cultural variations (8.33%). Attending Continuing Education Programs and training workshops were required to practice voice. Voice therapy methods (protocols) used by the SLPs were not uniform across India. The development of an indigenous protocol/method for voice therapy is the need of the hour.

Performance of Acoustic Measures for the Discrimination Among Healthy, Rough, Breathy, and Strained Voices Using the Feedforward Neural Network

OBJECTIVE

To identify and evaluate the best set of acoustic measures to discriminate among healthy, rough, breathy, and strained voices.

METHODS

This study used the vocal samples of the sustained /ε/ vowel from 251 patients with the vocal complaints, among which 51, 80, 63, and 57 patients exhibited healthy, rough, breathy, and strained voices, respectively. Twenty-two acoustic measures were extracted, and feature selection was applied to reduce the number of combinations of acoustic measures and obtain an optimal subset of measures according to the information gain attribute ranking algorithm. To classify signals as a function of predominant voice quality, a feedforward neural network was applied using a Levenberg-Marquardt supervised learning algorithm.

RESULTS

The best results were obtained from 11 combinations, with each combination presenting six acoustic measures. Kappa indices ranged from 0.7527 to 0.7743, the overall hit rates are 81.67%-83.27%, and the hit rates of healthy, rough, breathy, and strained voices are 74.51%-84.31%, 78.75%-90.00%, 85.71%-98.41%, and 68.42%-82.46%, respectively.

CONCLUSIONS

We obtained the best results from 11 combinations, with each combination exhibiting six acoustic measures for discriminating among healthy, rough, breathy, and strained voices. These sets exhibited good Kappa performance and a good overall hit rate. The hit rate varied between acceptable and good for healthy voices, acceptable and excellent for rough voices, good and excellent for breathy voices, and poor and good for strained voices.

Acoustic Voice Quality Index (AVQI) in the Measurement of Voice Quality: A Systematic Review and Meta-Analysis

INTRODUCTION

Acoustic Voice Quality Index (AVQI) is a multiparametric construct of voice quality recognized for its clinical and research applications around the globe. This study aimed to review the validity and diagnostic accuracy of AVQI (v02&03) and determine the effects of age and gender.

METHODS

This is a systematic review and meta-analysis registered with the PROSPERO registry. The authors searched two databases (PubMed and Cochrane Library database) for relevant studies. Studies selected for the systematic review were grouped based on study objectives. To determine the quality of the selected studies, the authors utilized the QUADAS-2 tool.

RESULTS

Meta-analysis of seven studies on AVQIv02 revealed a diagnostic threshold ranging from 2.72 to 3.33 for AVQIv02. In comparison, eight studies investigating AVQIv03 suggested a diagnostic threshold ranging from 1.33 to 3.15 for AVQIv03. Altogether, these studies demonstrated a pooled sensitivity and specificity of 0.85 and 0.92 for AVQIv02 and 0.82 and 0.92 for AVQIv03. The Area under the Curve was slightly better for AVQIv03 (0.94) than AVQIv02 (0.92). Three studies investigating the effect of age and gender on AVQI had a consensus that AVQI is independent of gender. However, findings were contradictory about the impact of age on AVQI.

CONCLUSIONS

AVQI is found to be a valid tool for the assessment of voice quality. AVQIv03 is slightly better than AVQIv02 in its diagnostic accuracy. AVQI is independent of gender. Because of the contradictory evidence, additional research on the effects of age on AVQI is necessary.

Comparison and Validation of Acoustic Voice Quality Index Version 2 and Version 3 among South Indian Population

BACKGROUND

Acoustic Voice Quality Index (AVQI) has emerged in the recent past as a robust multiparametric voice quality evaluation tool. Two versions of AVQI derived using the program PRAAT have found extensive clinical and research applications. These versions have been validated in several languages around the world. However, no research reports are available on validation of AVQI in the South Indian population. Further, studies comparing the performance of the two versions of AVQI are limited in the literature.

OBJECTIVES

This study was designed to validate and compare the two versions of AVQI (AVQIv02.02 and AVQIv03.01) in South Indian languages (Malayalam and Kannada).

METHODS

A retrospective analysis of previously recorded voice samples was carried out on a total of 160 (91 normophonic and 69 dysphonic) voice samples. These samples were perceptually rated on a GRBAS scale by five experienced speech-language pathologists. Standardized Syllable Number (SSN) necessary to derive AVQIv03.01 was computed. Following this, these samples were analyzed to obtain the AVQIv02.02 and AVQIv03.01. The concurrent validity and diagnostic accuracy of these measures were then examined and compared.

RESULTS

A moderate agreement was obtained across the judges on perceptual evaluation of voice quality. SSN in Malayalam and Kannada languages were identified to be 29 and 25 syllables respectively. Language differences were not observed on both versions of AVQI. The concurrent validity of AVQIv03.01 (r = 0.788) was superior to that of AVQIv02.02 (r = 0.655). Further, the threshold of differentiating normophonic and dysphonic samples were determined to be >3.45 for AVQIv02.02 and >2.45 for AVQIv03.01.

CONCLUSIONS

AVQIv03.01 is superior to AVQIv02.02 in terms of its diagnostic accuracy and concurrent validity. Current findings also extend the application of AVQI as a robust tool for the evaluation of voice characteristics to the South Indian population.

Comparative Analysis of CNN and RNN for Voice Pathology Detection

Diagnosis on the basis of a computerized acoustic examination may play an incredibly important role in early diagnosis and in monitoring and even improving effective pathological speech diagnostics. Various acoustic metrics test the health of the voice. The precision of these parameters also has to do with algorithms for the detection of speech noise. The idea is to detect the disease pathology from the voice. First, we apply the feature extraction on the SVD dataset. After the feature extraction, the system input goes into the 27 neuronal layer neural networks that are convolutional and recurrent neural network. We divided the dataset into training and testing, and after 10 k-fold validation, the reported accuracies of CNN and RNN are 87.11% and 86.52%, respectively. A 10-fold cross-validation is used to evaluate the performance of the classifier. On a Linux workstation with one NVidia Titan X GPU, program code was written in Python using the TensorFlow package.

The German Restructured Vocal Fatigue Index and Characteristics of Dysphonic and Vocally Healthy Populations

OBJECTIVE

The Vocal Fatigue Index (VFI), a 19-item psychometric self-report questionnaire, enables individuals with vocal fatigue (VF) to be identified and their complaints to be characterized. The purpose of this study was to improve the German-language version (VFI-G) and to evaluate further vocal fatigue-related characteristics of dysphonic and control populations.

METHODS

The VFI-G was restructured by replacing the three factors that structured the original: (1) tiredness of voice and voice avoidance; (2) physical discomfort; and (3) improvement of symptoms with rest, with two clusters developed on the basis of the results of a factor analysis by Nanjundeswaran et al. (2019). The two new clusters are: (1) tiredness and avoidance plus physical discomfort; and (2) symptom improvement through rest. One hundred one (101) individuals with voice disorders and 100 vocally healthy controls from a previous study that cross-validated the VFI-G participated in this study. In order to assess the validity of our newly adjusted VFI-G, independent samples t test, receiver operating characteristic curve, likelihood ratios and the Youden Index were calculated. The association of the two VF clusters with subject characteristics such as age, sex, type of voice disorder, and level of vocal usage was also analyzed using either a Pearson correlation or a one-way ANOVA for each of the two populations.

RESULTS

Significantly higher scores were obtained in voice-disordered subjects in both clusters (all P values < 0.001) than in healthy-voice subjects. The threshold for cluster 1 of the VFI-G was determined as ≥17.5 (74.3% sensitivity and 88.0% specificity). The results of cluster 2 are identical to that of factor 3 of the previous cross-validation study of the VFI-G. Most subject characteristics show no significant association with cluster 1 of the VFI-G, but cluster 2 seems to be moderately associated with age, type of voice disorder and level of vocal usage in the dysphonic population.

CONCLUSIONS

The restructured VFI-G showed improved validity and can be recommended for use in the assessment of VF. Cluster 2 is also moderately associated with several vocal fatigue-related subject characteristics of the dysphonic population.

The validity of the Acoustic Breathiness Index in the evaluation of breathy voice quality: A Meta-Analysis

BACKGROUND

The evaluation of voice quality with acoustic measurements is useful to objectify the diagnostic process. Particularly, breathiness was highly evaluated and the Acoustic Breathiness Index (ABI) might have promising features.

OBJECTIVE OF REVIEW

The goal of the present meta-analysis is to quantify, from existing cross-validation studies, the evidence for the diagnostic accuracy of ABI, including its sensitivity and specificity.

TYPE OF REVIEW

Meta-analysis.

SEARCH STRATEGY

We searched in MEDLINE, Google Scholar and Science Citation Index, and as manual search for the term Acoustic Breathiness Index from inception to February 2020. Studies were included that used equal proportion of continuous speech and sustained vowel segments, a recording hardware with a sufficient standard for voice signal analyses, the software Praat for signal processing and the customised Praat script, and two groups of subjects (vocally healthy and voice-disordered). Furthermore, the diagnostic accuracy of ABI was measured.

EVALUATION METHOD

The primary outcome variable was ABI. The score ranged from 0 to 10 with varying thresholds according to different languages to determine the absence or presence of breathiness. A meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses of diagnostic test accuracy study guidelines. Data were extracted, and the risk of bias was assessed using the QUADAS-2 tool. The pooled sensitivity and specificity of ABI were determined using a summary receiver operating characteristic (SROC) approach to calculate also a weighted threshold value of ABI with its sensitivity and specificity.

RESULTS

A total of 34 unique citations were screened, and 10 full-text articles were reviewed, including six studies. In total, 3603 voice samples were considered for further analysis separating into 467 vocally healthy and 3136 voice-disordered voice samples. The pooled sensitivity was 0.84 (95% CI, 0.83-0.85), and the pooled specificity was 0.92 (95% CI, 0.89-0.94). The area under the curve of the SROC curve of this analysis showed an excellent value of 0.94. The weighted ABI threshold was determined at 3.40 (sensitivity: 0.86, 95% CI, 0.84-0.87.; specificity: 0.90, 95% CI 0.88-0.92).

CONCLUSIONS

The results confirm the ABI as robust and valid objective measure for evaluating breathiness.

The effectiveness of voice therapy on voice-related handicap: A network meta-analysis

BACKGROUND

Treatment approaches for voice therapy are diverse, yet their differential effects are not well understood. Evaluations of treatment effects across approaches are important for clinical guidance and evidence-based practice.

OBJECTIVE OF REVIEW

To quantify the evidence of treatment effectiveness on the outcome measure Voice Handicap Index with the 30-items (VHI-30) from existing randomised controlled/clinical trials (RCT) of voice therapy using the statistical approach of a network meta-analysis (NMA) with a random effects model.

TYPE OF REVIEW

Meta-analysis.

SEARCH STRATEGY

We searched in MEDLINE (PubMed, 1950 to 2019), Embase (1974 to 2019) and Science Citation Index (1994 to 2019) using five key terms. The inclusion criteria were reports of randomised controlled/clinical trials (RCTs) published in English or German which evaluated the effectiveness of a specific voice therapy treatment using VHI-30 as an outcome measure in adult participants with non-organic or organic voice disorders. Studies were excluded if participants had been diagnosed with neurological motor speech disorders or who were vocally healthy. Furthermore, no medical, pharmacological or instrumental (eg voice amplification) treatments were considered.

EVALUATION METHOD

The primary outcome variable was VHI-30 with a score from 0 to 120. The pre-post treatment change in VHI-30 scores was an average score of 13 points related to various VHI-30 test-retest results.

RESULTS

We retrieved 464 publications (ie with duplicates) and included 13 RCTs, which evaluated nine interventions, in the final analysis. The most effective intervention with a significant and clinically relevant effect was Stretch-and-Flow Phonation (SFP) (mean pre-post difference -28.37, 95% confidence interval [CI], -43.05 to-13.68). Resonant Voice (RV), the Comprehensive Voice Rehabilitation Program (CVRP) and Vocal Function Exercises (VFE) also demonstrated significant improvements.

CONCLUSIONS

Of the nine voice interventions identified with the present NMA, SFP, RVT, CVRP, and VFE effectively improved VHI-30 scores from pre- to post-treatment. SFP proved to be the most significant and clinically relevant treatment. Further contributions of high-quality intervention studies are needed to support evidence-based practice in vocology.

A Survey on Machine Learning Approaches for Automatic Detection of Voice Disorders

The human voice production system is an intricate biological device capable of modulating pitch and loudness. Inherent internal and/or external factors often damage the vocal folds and result in some change of voice. The consequences are reflected in body functioning and emotional standing. Hence, it is paramount to identify voice changes at an early stage and provide the patient with an opportunity to overcome any ramification and enhance their quality of life. In this line of work, automatic detection of voice disorders using machine learning techniques plays a key role, as it is proven to help ease the process of understanding the voice disorder. In recent years, many researchers have investigated techniques for an automated system that helps clinicians with early diagnosis of voice disorders. In this paper, we present a survey of research work conducted on automatic detection of voice disorders and explore how it is able to identify the different types of voice disorders. We also analyze different databases, feature extraction techniques, and machine learning approaches used in these research works.

Study of Risk Factors for Development of Voice Disorders and its Impact on the Quality of Life of School Teachers in Mangalore, India

INTRODUCTION

School teachers are most prone to the development and detrimental effects of voice disorders as a consequence of their work. The risk factors for development of dysphonia in teachers are multifactorial.

AIM

The primary aim of our study was to investigate the various risk factors that influence the onset and progression of voice disorders in school teachers in the Indian context. We wanted to assess the effect of voice problems on the physical, psychosocial and functional aspect of a teacher's life.

MATERIALS AND METHODS

It was a cross-sectional study conducted across three English medium institutions. A total of 105 teachers consented to participate in the study and they had to answer a semi-structured, pre-tested questionnaire, which included demographic details, living habits (drug intake, smoking and alcohol intake) health condition [any Deviated Nasal Septum (DNS), Gastroesophageal Reflux Disease (GERD), stress, etc., or any history of surgery], teaching characteristics, voice symptoms and physical discomforts and quality of life assessment. The completed questionnaires were collected and analyzed based on the responses obtained.

RESULTS

It was found that 81% of the study population had voice problems at some point of their career. A total of 26% of them fell into the voice disorder category. The association of upper respiratory infections DNS and GERD with voice disorders was found to be statistically significant. We also found that a significant number of teachers with voice disorders had changed their teaching styles and were planning to opt for an early retirement. Most importantly, it was also seen that teachers with voice disorders were more likely to have a poorer quality of life as compared to those without a voice disorder (p<0.001).

CONCLUSION

Voice disorders had a significant bearing on all the spheres of a school teacher's life. The affected teachers were more likely to take sick leaves, change overall job opinions, retire early, reduce overall communiations, repeat statements and avoid talking to people in person as well as over the telephone. It reduced their overall social abilities and made them avoid social activities. They got easily upset and were dissatisfied with their job performance. All these in turn deteriorate the quality of life in these individuals.

A busca de evidências de validade no desenvolvimento de instrumentos em Fonoaudiologia: revisão sistemática

RESUMO Objetivo: Identificar, na literatura, o uso da Psicometria na área da Fonoaudiologia e os processos utilizados para a busca de evidências de validade dos instrumentos da área. Estratégia de pesquisa: As bases pesquisadas foram MEDLINE (acessado via PubMed), LILACS, Scopus e SciELO. Os descritores foram “Validation studies”, “Validity of tests”, “Speech, Language and Hearing Sciences” e “Valid” (seguido de elemento de truncagem), em português, inglês e espanhol. Critérios de seleção: Foram incluídos os estudos que realizavam algum tipo de validação de testes referentes a áreas da Fonoaudiologia. Resultados: Foram encontrados 296 artigos e destes, apenas 48 foram incluídos. A maioria dos estudos foi publicada por periódicos internacionais, da área da Fonoaudiologia e com amostra de ampla faixa etária. A principal área avaliada pelos instrumentos foi linguagem (20 estudos), seguida por audiologia (13 estudos). O ano de maior publicação foi 2014 e o principal tipo de busca de evidências de validade foi com base na estrutura interna. Conclusão: O uso dos princípios de busca de evidências de validade de instrumentos da área fonoaudiológica ainda é escasso. Porém, observa-se que a maior parte dos estudos foi desenvolvida nos últimos anos, demonstrando tendência atual para atenção à necessidade de aprimoramento dos instrumentos.

Clinical voice analysis of Carnatic singers

BACKGROUND AND OBJECTIVE

Carnatic singing is a classical South Indian style of music that involves rigorous training to produce an "open throated" loud, predominantly low-pitched singing, embedded with vocal nuances in higher pitches. Voice problems in singers are not uncommon. The objective was to report the nature of voice problems and apply a routine protocol to assess the voice.

METHODS

Forty-five trained performing singers (females: 36 and males: 9) who reported to a tertiary care hospital with voice problems underwent voice assessment. The study analyzed their problems and the clinical findings.

RESULTS

Voice change, difficulty in singing higher pitches, and voice fatigue were major complaints. Most of the singers suffered laryngopharyngeal reflux that coexisted with muscle tension dysphonia and chronic laryngitis. Speaking voices were rated predominantly as "moderate deviation" on GRBAS (Grade, Rough, Breathy, Asthenia, and Strain). Maximum phonation time ranged from 4 to 29 seconds (females: 10.2, standard deviation [SD]: 5.28 and males: 15.7, SD: 5.79). Singing frequency range was reduced (females: 21.3 Semitones and males: 23.99 Semitones). Dysphonia severity index (DSI) scores ranged from -3.5 to 4.91 (females: 0.075 and males: 0.64). Singing frequency range and DSI did not show significant difference between sex and across clinical diagnosis. Self-perception using voice disorder outcome profile revealed overall severity score of 5.1 (SD: 2.7). Findings are discussed from a clinical intervention perspective.

CONCLUSIONS

Study highlighted the nature of voice problems (hyperfunctional) and required modifications in assessment protocol for Carnatic singers. Need for regular assessments and vocal hygiene education to maintain good vocal health are emphasized as outcomes.