The influence of listener experience, measurement scale and speech task on the reliability of auditory-perceptual evaluation of vocal quality

PURPOSE

To assess the influence of the listener experience, measurement scales and the type of speech task on the auditory-perceptual evaluation of the overall severity (OS) of voice deviation and the predominant type of voice (rough, breathy or strain).

METHODS

22 listeners, divided into four groups participated in the study: speech-language pathologist specialized in voice (SLP-V), SLP non specialized in voice (SLP-NV), graduate students with auditory-perceptual analysis training (GS-T), and graduate students without auditory-perceptual analysis training (GS-U). The subjects rated the OS of voice deviation and the predominant type of voice of 44 voices by visual analog scale (VAS) and the numerical scale (score "G" from GRBAS), corresponding to six speech tasks such as sustained vowel /a/ and /ɛ/, sentences, number counting, running speech, and all five previous tasks together.

RESULTS

Sentences obtained the best interrater reliability in each group, using both VAS and GRBAS. SLP-NV group demonstrated the best interrater reliability in OS judgment in different speech tasks using VAS or GRBAS. Sustained vowel (/a/ and /ɛ/) and running speech obtained the best interrater reliability among the groups of listeners in judging the predominant vocal quality. GS-T group got the best result of interrater reliability in judging the predominant vocal quality.

CONCLUSION

The time of experience in the auditory-perceptual judgment of the voice, the type of training to which they were submitted, and the type of speech task influence the reliability of the auditory-perceptual evaluation of vocal quality.

Auditory-Perceptual Judgment of Vocal Resonance in Carnatic Singers by Different Groups of Listeners

AIM

This study was aimed at evaluating the auditory perceptual judgments of vocal resonance by professional singers, speech-language pathologists (SLP) with singing training, and SLPs without singing training.

OBJECTIVES

(a) To examine the auditory-perceptual judgments of the phonation samples of professional singers obtained before and after resonant voice therapy (RVT) by professional singers, SLPs with singing training, and SLPs without singing training. (b) To compare the agreement between the auditory-perceptual judgments of the phonation samples obtained before and after RVT by professional singers, SLPs with singing training, and SLPs without singing training METHOD: Three groups of judges formed the participants of the study: group A (professional singers), group B (SLPs with singing training), and group C (SLPs without singing training). The judges were instructed to evaluate the perceptual vocal resonance in the voice samples of two groups of trained Carnatic classical singers.Among these groups, One group received RVT training, and their voice samples were obtained before and after the training, while the other group acted as a control. An auditory perceptual 3-point rating scale was used to rate the vocal resonance. Descriptive and inferential statistical analyses and inter-rater agreement tests were done to understand the auditory perceptual judgment of vocal resonance by the three groups of judges.

RESULTS

The results of the Wilcoxon signed rank test indicated that the post-training auditory perceptual ratings by group A (│Z│ = 2.66; P = 0.008) and group B (│Z│ = 2.36; P = 0.018) were significantly different from their pre-training perceptual rating scores. The post-training ratings by group C were not statistically different compared to their pre-training scores. Also, good agreement levels were found on the weighted Cohen's Kappa coefficient test performed on the judgments made by groups A and B.

CONCLUSION

The listeners compare the voice samples to their own internal representations of a voice which would exclusively depend on the experiences of the listeners. In that way, the perception of intricate voice features of singers, like vocal resonance, could be challenging for SLPs with no experience in singing. The results of this study propose specific training in auditory perceptual judgments for SLPs to ensure efficient and independent service delivery to elite vocal performers like singers.

Comparative Analysis of Two Methods of Perceptual Voice Assessment

OBJECTIVES

The primary aim was to compare two methods for perceptual evaluation of voice - paired comparison (PC) and visual analog scale (VAS) ratings. Secondary aims were to assess the correspondence between two dimensions of voice- overall severity of voice quality and resonant voice, and to investigate the influence of rater experience on perceptual rating scores and rating confidence scores.

STUDY DESIGN

Experimental design.

METHODS

Voice samples from six children (pre and post therapy) were rated by 15 Speech-Language Pathologists specialized in voice. Raters completed four tasks corresponding to the two rating methods and voice qualities: PC-severity, PC-resonance, VAS-severity, and VAS-resonance. For PC tasks, raters chose the better of two voice samples (better voice quality or better resonance, depending on the task) and indicated the degree of confidence in each choice. Rating and confidence score were combined to produce a number on a 1-10 scale (PC-confidence adjusted). VAS ratings involved rating voices on a scale for degree of severity and resonance, respectively.

RESULTS

PC-confidence adjusted and VAS ratings were moderately correlated for overall severity and also vocal resonance. VAS ratings were normally distributed and had greater rater consistency than PC-confidence adjusted ratings. VAS scores reliably predicted binary PC choices (choice of voice sample only). Overall severity and vocal resonance were weakly correlated and rater experience was not linearly related to rating scores or confidence.

CONCLUSIONS

Results suggest that the VAS rating method holds advantages over PC, including normally distributed ratings, superior consistency of ratings, and the ability to provide more finely grained detail regarding the auditory perception of voice. Overall severity and vocal resonance were not redundant in the current data set, suggesting that resonant voice and overall severity are not isomorphic. Finally, the number of years of clinical experience was not linearly related to perceptual ratings or rating confidence.

Clinical Use of the CAPE-V Scales: Agreement, Reliability and Notes on Voice Quality

OBJECTIVES

The CAPE-V is a widely used protocol developed to help standardize the evaluation of voice. Variability of voice quality ratings has prevented development of training protocols that might themselves improve interrater agreement among new clinicians. As part of a larger mixed methods project, this study examines agreement and reliability for experienced clinicians using the CAPE-V scales.

STUDY DESIGN

Observational.

METHODS

Experienced voice clinicians (N=20) provided ratings of recordings from 12 speakers representing a range of overall voice quality. Participants were instructed to rate the voices as they normally would, using the CAPE-V scales. Descriptive data were recorded and two levels of agreement were calculated. Single rater reliability was calculated using a 2-way random model of absolute agreement for intraclass correlations (ICC [2,1]).

RESULTS

Participants use of the CAPE-V scales varied considerably, although most rated overall severity, breathiness, roughness and strain. Data from one participant did not meet a priori agreement criteria. Because outcomes were significantly different without their data, agreement and reliability were analyzed based on the reduced data set from 19 participants. Interrater agreement and reliability were comparable to previous research; the mean range of ratings was at least 47mm for all dimensions of voice quality.

CONCLUSIONS

Results indicated differential use of the components of the CAPE-V form and scales in evaluating voice quality and severity of dysphonia, including categorical variability among ratings of all of the primary CAPE-V dimensions of voice quality that may complicate the clinical description of a voice as mildly, moderately or severely dysphonic.

Mitigating Dysphonia, Pain, and Vocal Handicap after Violent Video Game Voice Overs: A Pilot Investigation into Vocal Combat Technique Training

OBJECTIVE

to investigate how the Vocal Combat Technique (VCT) may mitigate vocal symptoms in voice over actors using vocal violence.

METHODS

Five voice over actors (3 male, 2 females, Mean = 29.6 years) completed two study sessions of 45 minutes-to-1 hour of vocally violent voice over work held approximately 4 weeks apart. During session one, participants completed voice over work as they typically would, whereas they received 3-hours of VCT training to improve/assist in healthy vocal techniques prior to session two. Pre- and post-session measures for both sessions included self-perceptual ratings of vocal symptoms, auditory-perceptual evaluation, and traditional acoustic measures of frequency and perturbation.

RESULTS

Participants showed substantial mitigating effects of VCT training on acoustic perturbation measures (jitter, shimmer, harmonics-to-noise ratio), and self-ratings of vocal symptoms (Vocal-Handicap Index-10, McGill Pain Scale for vocal discomfort, and Evaluation of the Ability to Sing Easily) with calculated medium to large effect sizes (d = 0.61-1.95). There were no changes in auditory perceptual ratings across sessions.

CONCLUSION

Our pilot investigation yielded positive improvements in vocal symptomology in five voice over actors who were trained in VCT. Next steps should include a larger enrollment of voice actors to determine optimal preventative and recovery techniques.

Influence of Phonatory Break Duration and Pause Time on Auditory-Perceptual Ratings of Speech Aceptability and Listener Comfort in Adductor-Type Laryngeal Dystonia

INTRODUCTION

This study empirically evaluated the influence of phonatory break duration and pause time on auditory-perceptual measures of speech produced by 26 adult speakers diagnosed with adductor-type laryngeal dystonia (AdLD).

TYPE OF STUDY

Experimental.

METHODS

Fifteen inexperienced, young adult normal-hearing listeners provided ratings of speech acceptability and listener comfort for samples of running speech. Four phonatory break and pause time conditions were assessed using visual analog scaling methods. All stimuli were randomized for presentation and listeners were presented with experimental stimuli in a counterbalanced manner.

RESULTS

Results indicate that the duration of phonatory breaks directly influenced listener ratings of speech acceptability (P < 0.001) and listener comfort (P < 0.001), with significant differences between original and modified recordings for both. Speech acceptability and listener comfort ratings were strongly correlated across all timing conditions (r = 0.85-0.97).

CONCLUSIONS

The duration of phonatory breaks and pauses have significantly influence judgments of speech acceptability and listener comfort for AdLD. This suggests that temporal factors such as phonatory break duration and pause time in AdLD may carry substantial negative impact on listeners' perception relative to other auditory-perceptual features that co-exist in the signal.

Perceptions regarding communicative participation in individuals receiving botulinum toxin injections for laryngeal dystonia

BACKGROUND

Laryngeal dystonia (LD), or spasmodic dysphonia (SD), is a neurological disorder characterized by focal dystonia or involuntary spasms of the laryngeal muscles and associated voice symptoms. It is typically treated with injection of botulinum toxin (BoNT) that weakens the affected muscles.

AIMS

The primary purpose of this qualitative study was to explore participants' experience of living with LD and BoNT treatment. The secondary purpose was to examine those experiences as a function of participants' scores on the Communicative Participation Item Bank (CPIB). Results will enhance our understanding of restrictions in communicative participation, assist in planning intervention targeting these restrictions and aid in clinical interpretation of CPIB scores.

METHODS & PROCEDURES

Semi-structured interviews using a phenomenological tradition and focusing on BoNT treatment and communicative participation were conducted with 26 people with LD who are on established BoNT treatment regimens. Interviews were recorded, transcribed, coded and analysed inductively. Participants were categorized by CPIB scores into groups ranging from none to extensive participation restrictions. Both self- and expert ratings of voice were obtained.

OUTCOMES & RESULTS

Participants with different levels of CPIB scores had different experiences related to communicative participation in the context of BoNT treatment. These differences were organized into the following topics: BoNT and voice; attitudes toward participation; coping strategies; and advice. For all participants except those in the least restricted and most restricted groups, expert ratings of voice did not relate to CPIB scores.

CONCLUSIONS & IMPLICATIONS

Although most participants report improved voice with BoNT treatment, many participants experienced lingering restrictions in communicative participation, some to a severe extent. Participants reported coping with these restrictions in many ways; some of these strategies were more successful than others. Those with restricted participation recommended more support for daily life and the emotional toll of LD, as well as support for family members. This support might be offered by speech-language pathologists.

WHAT THIS PAPER ADDS

What is already known on the subject Participants with different levels of CPIB scores had different experiences related to communicative participation in the context of BoNT treatment. What this study adds to the existing knowledge Although most participants report improved voice with BoNT treatment, many participants experienced lingering restrictions in communicative participation, some to a severe extent. What are the potential or actual clinical implications of this work? SLP services that take a participation-focused approach to intervention and use multi-factorial approaches to help clients maximize their life participation in the context of LD are well within the SLP scope of practice. SLPs can help clients find and use their optimal voices within the constraints of the dystonia and BoNT effects.

Disclosure of a communication disorder during a job interview: A theoretical model

With the passage of the Americans with Disabilities Act Amendments Act of 2008 (ADAAA), the definition of disability was expanded and the terms "speaking, hearing, and communicating" were given status as major life activities. Therefore, any communication disorder which substantially limits these major life activities in the workplace can qualify as a disability under the law. This legal protection means that no employer can ever ask about the presence of a communication disorder, and a job applicant is never required to disclose their communication disorder during the hiring process. However, this right to refrain from disclosure potentially places job applicants in a difficult situation. Applicants can choose to remain silent about their disorder and hopefully avoid hiring discrimination, yet the only way that workplace accommodations can be legally requested is if disclosure of the disability takes place. This disclosure decision-making process is likely complex and dependent upon multiple factors. Aspects such as workplace culture, job duties, severity of symptoms, individual motivations, and characteristics of the communication disorder likely all play a role when weighing the decision to disclose. This article proposes a theoretical model which outlines the factors that might influence the disclosure decision-making process for those with communication disorders before a job interview. Each major component of this decision-making process is highlighted, focusing on which factors might inhibit or foster disclosure within a hiring context. Clinical implications are discussed which can allow speech-language pathologists to assist those who are struggling with this important decision. The article also identifies areas in need of future research.

Acoustic Model of Perceived Overall Severity of Dysphonia in Adductor-Type Laryngeal Dystonia

Purpose This study is a secondary analysis of existing data. The goal of the study was to construct an acoustic model of perceived overall severity of dysphonia in adductory laryngeal dystonia (AdLD). We predicted that acoustic measures (a) related to voice and pitch breaks and (b) related to vocal effort would form the primary elements of a model corresponding to auditory-perceptual ratings of overall severity of dysphonia. Method Twenty inexperienced listeners evaluated the overall severity of dysphonia of speech stimuli from 19 individuals with AdLD. Acoustic features related to primary signs of AdLD (hyperadduction resulting in pitch and voice breaks) and to a potential secondary symptom of AdLD (vocal effort, measures of relative fundamental frequency) were computed from the speech stimuli. Multiple linear regression analysis was applied to construct an acoustic model of the overall severity of dysphonia. Results The acoustic model included an acoustic feature related to pitch and voice breaks and three acoustic measures derived from relative fundamental frequency; it explained 84.9% of the variance in the auditory-perceptual ratings of overall severity of dysphonia in the speech samples. Conclusions Auditory-perceptual ratings of overall severity of dysphonia in AdLD were related to acoustic features of primary signs (pitch and voice breaks, hyperadduction associated with laryngeal spasms) and were also related to acoustic features of vocal effort. This suggests that compensatory vocal effort may be a secondary symptom in AdLD. Future work to generalize this acoustic model to a larger, independent data set is necessary before clinical translation is warranted.

The Effects of Contextual Priming and Alaryngeal Speech Mode on Auditory-Perceptual Ratings of Listener Comfort

BACKGROUND

The effectiveness of postlaryngectomy communication methods (esophageal, tracheoesophageal, and electrolaryngeal speech) has been primarily evaluated using functional outcomes. This evaluation neglects the importance of listeners and their influence on communicative effectiveness. Listener comfort (LC), or the ease with which a listener interacts with alaryngeal speakers, may provide an important index of communicative effectiveness. The present study investigated the use of LC in the auditory-perceptual evaluation of alaryngeal speech modes, as well as evaluating the influence of contextual cues used to elicit ratings on listener judgments of all three alaryngeal modes.

METHODS

Thirty-three naïve listeners provided independent ratings of LC for 39 alaryngeal speech samples using a visual analogue scaling procedure. Each group of listeners rated alaryngeal speech in three imagined listening conditions (Telephone Conversation, Social Situation, and a non-specified Control Condition). To analyze LC ratings obtained, a 3 × 3 mixed factor analysis of variance was conducted.

RESULTS

A significant interaction effect between alaryngeal speech mode and listening condition (P = 0.04) was identified. Overall, pairwise comparisons of alaryngeal speech mode indicated that listeners were more comfortable when presented with tracheoesophageal speech samples compared to those of esophageal and electrolaryn geal speakers.

CONCLUSIONS

Our data suggest that LC ratings are influenced by alaryngeal speech mode. Tracheoesophagea speech was perceived to have the most favorable LC ratings compared to the other alaryngeal speech modes in all listening conditions. Contextual cues (i.e., social condition and telephone condition) did not have an effect on LC ratings.

Effect of the Visual Presentation of a Craniofacial Syndrome on Speech Intelligibility in Noise

OBJECTIVE

Research has argued that a speaker's facial appearance can result in an "intelligibility cost" for the listener. The study investigated whether such an intelligibility cost exists for a visible repaired cleft lip and nasal asymmetry.

SETTING

University department.

PARTICIPANTS

Eight typical speakers provided speech samples. Twenty-eight naive listeners participated in a speech in noise experiment.

INTERVENTIONS

Listeners transcribed sentences in noise that were paired with faces of individuals with repaired cleft lip and nasal asymmetry or typical faces. They also rated speaker intelligibility and answered a questionnaire about their previous knowledge about cleft lip and palate.

MAIN OUTCOME MEASURES

Percentage of words transcribed correctly and intelligibility ratings, compared by experimental condition (photo of typical face or face with repaired cleft lip and nasal asymmetry) and speaker gender.

RESULTS

There were no statistically significant differences between speech stimuli that were presented with faces with repaired cleft lip and nasal asymmetry or typical faces. The percentage of words transcribed correctly by the listeners was lower for female speakers (F = 12.7, df = 1; P < .01). Speech intelligibility of female speakers was rated more poorly (F = 10.5, df = 1; P < .01).

CONCLUSIONS

Presence of a repaired cleft lip and nasal asymmetry did not result in an intelligibility cost for naive listeners. Future research should investigate possible effects of facial motion or previous knowledge.

The relationship between acoustical and perceptual measures of vocal effort

Excessive vocal effort is a common clinical voice symptom, yet the acoustical manifestation of vocal effort and how that is perceived by speakers and listeners has not been fully elucidated. Here, 26 vocally healthy adults increased vocal effort during the production of the utterance /ifi/, followed by self-ratings of effort on a 100 mm visual analog scale. Twenty inexperienced listeners assessed the speakers' vocal effort using the visual sort-and-rate method. Previously proposed acoustical correlates of vocal effort were calculated, including: mean sound pressure level (SPL), mean fundamental frequency (f o), relative fundamental frequency (RFF) offset cycle 10 and onset cycle 1, harmonics-to-noise ratio (HNR), cepstral peak prominence and its standard deviation (SD), and low-to-high (L/H) spectral ratio and its SD. Two separate mixed-effects regression models yielded mean SPL, L/H ratio, and HNR as significant predictors of both speaker and listener ratings of vocal effort. RFF offset cycle 10 and mean f o were significant predictors of listener ratings only. Therefore, speakers and listeners attended to similar acoustical cues when making judgments of vocal effort, but listeners also used additional time-based information. Further work is needed to determine how vocal effort manifests in the speech signal in speakers with voice disorders.

The influence of clear speech on auditory-perceptual judgments of electrolaryngeal speech

PURPOSE

To determine the influence of clear speech on auditory-perceptual judgments of speech acceptability and listener comfort for electrolaryngeal speech.

METHOD

Voice recordings were obtained from 10 electrolaryngeal speakers. Each speaker read the Rainbow Passage in two conditions: habitual speech and clear speech. Speakers were encouraged to speak as clearly as possible and over-articulate in the clear speech condition. Auditory-perceptual rating tasks were completed by 20 normal-hearing adults who evaluated 20 randomized voice recordings. Two counterbalanced listening sessions were used to gather ratings of speech acceptability and listener comfort.

RESULTS

A significant effect of speaking condition was found on listener judgments of speech acceptability, but not listener comfort. However, listener scores for speech acceptability and listener comfort were found to be significantly related. For all speakers, objective temporal measures indicated reduced speaking rates in the clear speech condition.

CONCLUSIONS

These findings suggest that volitional attempts to improve electrolaryngeal speech using clear speech might negatively impact listener judgments of speech acceptability, but not listener comfort. Further, the data suggest that speech acceptability and listener comfort might address unique perceptual entities. Overall, the strong relationship between these auditory-perceptual dimensions provide support for the use of scaled measurements to assess the impact of speech rehabilitation on individuals who use the electrolarynx.

The Effect of Information and Severity on Perception of Speakers With Adductor Spasmodic Dysphonia

PURPOSE

The purpose of this study was to examine the effect of severity of adductor spasmodic dysphonia (ADSD) and information about it on unfamiliar listeners' attitudes about speakers' personal characteristics, perceived vocal effort, and listener comfort on the basis of ratings of speech recordings.

METHOD

Fifteen women with ADSD and 5 controls provided speech samples. Forty-five unfamiliar listeners were randomized into 3 groups. Listeners in Group 1 received no information, listeners in Group 2 were told that some speakers had voice disorders or had no voice concerns, and listeners in Group 3 were provided diagnostic labels for each speaker and information about ADSD. Listeners then rated speech samples for attitudes, perceived vocal effort, and listener comfort.

RESULTS

Speakers with ADSD were judged significantly worse than controls for attitudes related to "social desirability" and "intellect." There was no effect of severity on "personality" attributes. However, provision of a diagnostic label resulted in significantly more favorable personality ratings than when no label was provided. Perceived vocal effort and comfort became significantly more negative as ADSD severity increased. Finally, most listener ratings were unaffected by provision of additional information about ADSD.

CONCLUSIONS

Listeners' perceptions about speakers with ADSD are difficult to change. Directions for counseling and public education need future study.

Assessment practices of Irish speech and language therapists in the evaluation of voice disorders

It is commonly accepted that the evaluation of voice disorders ought to include extensive perceptual, psychometric, and instrumental measurements. This serves to encapsulate the wide-reaching effects of such a disorder, from the physical impairment in voice production to the psycho-social impact of having a dysphonic voice. In spite of this, no international gold standard exists by which voice disorders should be evaluated, and so speech and language therapists (SLTs) are often tasked with developing an assessment battery for use in their own clinics. The purpose of this study is to determine whether the evaluation of voice disorders by Irish SLTs on a national scale is suitably comprehensive, with particular reference to the guidelines published by the European Laryngological Society. A total of 49 SLTs working in a variety of settings responded anonymously to an electronic survey regarding their assessment practices. Results indicate that therapists are comprehensive in non-instrumental evaluation of voice, but lack both access to and training in instrumental assessment techniques.

The Impact of Dysphonic Voices on Healthy Listeners: Listener Reaction Times, Speech Intelligibility, and Listener Comprehension

PURPOSE

There is currently minimal information on the impact of dysphonia secondary to phonotrauma on listeners. Considering the high incidence of voice disorders with professional voice users, it is important to understand the impact of a dysphonic voice on their audiences.

METHODS

Ninety-one healthy listeners (39 men, 52 women; mean age = 23.62 years) were presented with speech stimuli from 5 healthy speakers and 5 speakers diagnosed with dysphonia secondary to phonotrauma. Dependent variables included processing speed (reaction time [RT] ratio), speech intelligibility, and listener comprehension. Voice quality ratings were also obtained for all speakers by 3 expert listeners.

RESULTS

Statistical results showed significant differences between RT ratio and number of speech intelligibility errors between healthy and dysphonic voices. There was not a significant difference in listener comprehension errors. Multiple regression analyses showed that voice quality ratings from the Consensus Assessment Perceptual Evaluation of Voice (Kempster, Gerratt, Verdolini Abbott, Barkmeier-Kraemer, & Hillman, 2009) were able to predict RT ratio and speech intelligibility but not listener comprehension.

CONCLUSIONS

Results of the study suggest that although listeners require more time to process and have more intelligibility errors when presented with speech stimuli from speakers with dysphonia secondary to phonotrauma, listener comprehension may not be affected.

Individual Monitoring of Vocal Effort With Relative Fundamental Frequency: Relationships With Aerodynamics and Listener Perception

PURPOSE

The acoustic measure relative fundamental frequency (RFF) was investigated as a potential objective measure to track variations in vocal effort within and across individuals.

METHOD

Twelve speakers with healthy voices created purposeful modulations in their vocal effort during speech tasks. RFF and an aerodynamic measure of vocal effort, the ratio of sound pressure level to subglottal pressure level, were estimated from the aerodynamic and acoustic signals. Twelve listeners also judged the speech samples for vocal effort using the visual sort and rate method.

RESULTS

Relationships between RFF and both the aerodynamic and perceptual measures of vocal effort were weak across speakers (R2 = .06-.26). Within speakers, relationships were variable but much stronger on average (R2 = .45-.56).

CONCLUSIONS

RFF showed stronger relationships between both the aerodynamic and perceptual measures of vocal effort when examined within individuals versus across individuals. Future work is necessary to establish these relationships in individuals with voice disorders across the therapeutic process.

Descriptive Epidemiology of Voice Disorders in Rheumatoid Arthritis: Prevalence, Risk Factors, and Quality of Life Burden

OBJECTIVES

Rheumatoid arthritis (RA) is an autoimmune inflammatory disease which may adversely affect phonatory function. This study aimed to establish the prevalence, risks, and quality of life effects of voice disorders in RA.

STUDY DESIGN

This is a cross-sectional, descriptive epidemiology study.

METHODS

One hundred individuals with RA underwent a telephone interview to determine the frequency, severity, risks associated with, and quality of life burden of voice disorders. The results were analyzed using summary statistics, frequencies, chi-square tests, regression analysis, and risk ratios (P < 0.05).

RESULTS

Thirty-five percent of participants with RA reported a current voice disorder which was chronic and long-standing in most cases. The prevalence of a current voice disorder did not significantly differ across age, sex, medication use, voice use patterns, medical history, or RA severity. These chronic voice disorders produced significant adverse effects on both voice-related quality of life and short form 36 health-related quality of life scales. Specific voice symptoms such as "voice-related discomfort" and "chronic throat dryness" contributed disproportionately to the quality of life burden. Of those participants with a voice disorder, only 37% had ever sought professional help to improve their voice.

CONCLUSIONS

These results indicate that voice disorders are common in RA and produce significant adverse effects on quality of life. Further research is necessary to better understand the origin of these disorders and their potential response to treatment.

Voice, Speech, and Laryngeal Features of Primary Sjögren’s Syndrome

Objective:

This study examined voice, speech, and laryngeal characteristics in primary Sjögren’s syndrome (pSS).

Methods:

Eleven patients (10 female, 1 male; mean [SD] age = 57 [14] years) from The University of Utah Division of Rheumatology provided connected speech and sustained vowel samples. Analyses included the Multi-Dimensional Voice Profile, the Analysis of Dysphonia in Speech and Voice, and dysphonia severity, speech clarity, and videolaryngostroboscopy ratings.

Results:

Shimmer, amplitude perturbation quotient, and average fundamental frequency differed significantly from normative values ( P < .01). Cepstral Spectral Index of Dysphonia values indicated mild-to-moderate dysphonia in connected speech (mean [SD] = 20.26 [8.36]) and sustained vowels (mean [SD] = 16.91 [11.08]). Ratings of dysphonia severity and speech clarity using 10-cm visual analog scales suggested mild-to-moderate dysphonia in connected speech (mean [SD] = 2.11 [1.72]) and sustained vowels (mean [SD] = 3.13 [2.20]) and mildly reduced speech clarity (mean [SD] = 1.46 [1.36]). Videolaryngostroboscopic ratings indicated mild-to-moderate dryness and mild reductions in overall laryngeal function. Voice Handicap Index scores indicated mild-to-moderate voice symptoms (mean [SD] = 43 [23]).

Conclusion:

Individuals with pSS may experience dysphonia and articulatory imprecision, typically in the mild-to-moderate range. These findings have implications for diagnostic and referral practices in pSS.

Inferring speaker attributes in adductor spasmodic dysphonia: ratings from unfamiliar listeners

PURPOSE

To determine whether unfamiliar listeners' perceptions of speakers with adductor spasmodic dysphonia (ADSD) differ from control speakers on the parameters of relative age, confidence, tearfulness, and vocal effort and are related to speaker-rated vocal effort or voice-specific quality of life.

METHOD

Twenty speakers with ADSD (including 6 speakers with ADSD plus tremor) and 20 age- and sex-matched controls provided speech recordings, completed a voice-specific quality-of-life instrument (Voice Handicap Index; Jacobson et al., 1997), and rated their own vocal effort. Twenty listeners evaluated speech samples for relative age, confidence, tearfulness, and vocal effort using rating scales.

RESULTS

Listeners judged speakers with ADSD as sounding significantly older, less confident, more tearful, and more effortful than control speakers (p < .01). Increased vocal effort was strongly associated with decreased speaker confidence (rs = .88-.89) and sounding more tearful (rs = .83-.85). Self-rated speaker effort was moderately related (rs = .45-.52) to listener impressions. Listeners' perceptions of confidence and tearfulness were also moderately associated with higher Voice Handicap Index scores (rs = .65-.70).

CONCLUSION

Unfamiliar listeners judge speakers with ADSD more negatively than control speakers, with judgments extending beyond typical clinical measures. The results have implications for counseling and understanding the psychosocial effects of ADSD.

Voice Symptoms and Voice-Related Quality of Life in College Students

Objectives:

The purpose of this study was to examine the prevalence of voice disorders in college students and their effect on the students as shown by quality-of-life indicators.

Methods:

A cross-sectional survey was completed by 545 college students in 2012. The survey included 10 questions from the Voice-Related Quality of Life (V-RQOL), selected voice symptoms, and quality-of-life indicators of functional health and well-being based on the Short Form 36-item Health Survey (SF-36).

Results:

Twenty-nine percent of the college students (mean age, 22.7 years) reported a history of a voice disorder. Hoarseness was the most prevalent voice symptom, but was not correlated with V-RQOL scores. A wobbly or shaky voice, throat dryness, vocal fatigue, and vocal effort explained a significant amount of variance on the social-emotional and physical domains of the V-RQOL index (p < 0.05). Voice symptoms limited emotional and physical functioning as indicated by SF-36 scores.

Conclusions:

Voice disorders significantly influence psychosocial and physical functioning in college students. These findings have important implications for voice-care services in this population.

Voice-Related Symptoms and Their Effects on Quality of Life

Objectives:

The purpose of this study was to identify the extent to which selected voice symptoms formed underlying constructs called factors, and the degree to which these factors influenced specific quality-of-life domains among a group of relatively healthy older adults.

Methods:

A cross-sectional survey was completed in October 2010 by 461 individuals 50 years of age and older. The questionnaire items included demographics, medical history, health, voice use, and voice symptoms. Quality-of-life indicators were used from the Short Form 36 Health Survey, an 8-scale measure of functional health and well-being.

Results:

Two clusters of symptoms were identified in the factor analysis. One cluster, consisting of 5 voice-related symptoms and labeled “phonatory effort,” shared all significant negative correlations with health outcomes, whereas the other cluster, consisting of 2 voice-related symptoms and labeled “chronic throat condition,” had a pattern of sharing significant negative correlations with only 3 health outcomes. All voice symptoms had significant negative correlations with general health, bodily pain, and energy/fatigue.

Conclusions:

Voice-related symptoms share complex relationships with and have negative effects on health outcomes. The specific mechanisms of impact need further research in order for us to better understand these effects on quality of life and how to prevent and treat the symptoms.

Acoustic Correlate of Vocal Effort in Spasmodic Dysphonia

Objectives:

This study characterized the relationship between relative fundamental frequency (RFF) and listeners' perceptions of vocal effort and overall spasmodic dysphonia severity in the voices of 19 individuals with adductor spasmodic dysphonia.

Methods:

Twenty inexperienced listeners evaluated the vocal effort and overall severity of voices using visual analog scales. The squared correlation coefficients (R2) between average vocal effort and overall severity and RFF measures were calculated as a function of the number of acoustic instances used for the RFF estimate (from 1 to 9, of a total of 9 voiced-voiceless-voiced instances).

Results:

Increases in the number of acoustic instances used for the RFF average led to increases in the variance predicted by the RFF at the first cycle of voicing onset (onset RFF) in the perceptual measures; the use of 6 or more instances resulted in a stable estimate. The variance predicted by the onset RFF for vocal effort (R2 range, 0.06 to 0.43) was higher than that for overall severity (R2 range, 0.06 to 0.35). The offset RFF was not related to the perceptual measures, irrespective of the sample size.

Conclusions:

This study indicates that onset RFF measures are related to perceived vocal effort in patients with adductor spasmodic dysphonia. These results have implications for measuring outcomes in this population.

Listener effort for highly intelligible tracheoesophageal speech

The purpose of this study was to determine whether: (a) inexperienced listeners can reliably judge listener effort and (b) whether listener effort provides unique information beyond speech intelligibility or acceptability in tracheoesophageal speech. Twenty inexperienced listeners made judgments of speech acceptability and amount of effort required to listen to 14 male tracheoesophageal speakers using a paired comparison paradigm. Intelligibility was controlled to limit the analysis to the relationship between ratings of listener effort and speech acceptability. Results showed that as a group, inexperienced listeners reliably rated both speech acceptability and listener effort. In addition, ratings of speech acceptability and listener effort were strongly correlated (r>.99); however, there was evidence that some individual listeners assigned different ratings for each dimension for the same speech samples. Results have important implications for communication success for tracheoesophageal speakers.

LEARNING OUTCOMES

Readers will be able to describe: (a) the measurement of listener burden in speech and (b) the differences and relationships among listener effort, speech acceptability and speech intelligibility.

The Levels of Speech Usage rating scale: comparison of client self-ratings with speech pathologist ratings

BACKGROUND

The term 'speech usage' refers to what people want or need to do with their speech to fulfil the communication demands in their life roles. Speech-language pathologists (SLPs) need to know about clients' speech usage to plan appropriate interventions to meet their life participation goals. The Levels of Speech Usage is a categorical scale intended for client self-report of speech usage, but SLPs may want the option to use it as a proxy-report tool. The relationship between self-report and clinician ratings should be examined before the instrument is used in a proxy format.

AIMS

The primary purpose of this study was to compare client self-ratings with SLP ratings on the Levels of Speech Usage scale. The secondary purpose was to determine if the SLP ratings differed depending on whether or not the SLPs knew about the clients' medical condition.

METHODS & PROCEDURES

Self-ratings of adults with communication disorders on the Levels of Speech Usage scale were available from prior research. Vignettes about these individuals were created from existing data. Two sets of vignettes were created. One set contained information about demographic information, living situation, occupational status and hobbies or social activities. The second set was identical to the first with the addition of information about the clients' medical conditions and communication disorders. Various communication disorders were represented including dysarthria, voice disorders, laryngectomy, and mild cognitive and language disorders. Sixty SLPs were randomly divided into two groups with each group rating one set of vignettes. The task was completed online. While this does not replicate typical in-person clinical interactions, it was a feasible method for this study. For data analysis, the client self-ratings were considered fixed points and the percentage of SLP ratings in agreement with the self-ratings was calculated.

OUTCOMES & RESULTS

The percentage of SLP ratings in exact agreement with client self-ratings was 44.9%. Agreement was lowest for the less-demanding speech usage categories and highest for the most demanding usage category. There was no significant difference between the two groups of SLPs based on knowledge of medical condition.

CONCLUSIONS & IMPLICATIONS

SLPs often need to document the speech usage levels of clients. This study suggests the potential for SLPs to misjudge how clients see their own speech demands. Further research is needed to determine if similar results would be found in actual clinical interactions. Until then, SLPs should seek the input of their clients when using this instrument.

The effect of listener experience and anchors on judgments of dysphonia

PURPOSE

To determine the effect of auditory anchors on judgments of overall severity (OS) and vocal effort (VE) in dysphonic speech when judgments are made by experienced and inexperienced listeners, and when self-rated by individuals with dysphonia (speaker-listeners).

METHOD

Twenty individuals with dysphonia and 4 normal controls provided speech recordings. Speaker-listeners judged their own speech samples for OS and VE without auditory anchors, and then in the presence of anchors, using 100-mm visual analog scales (VAS). Twenty inexperienced and 10 experienced listeners evaluated the same speech samples for OS and VE in similar rating conditions. Twenty inexperienced listeners also made judgments of the speech samples solely in anchored conditions.

RESULTS

All listeners judged the speech samples as significantly less severe and effortful in the anchored conditions. No significant effects of anchors or experience were found for intrarater agreement within 7.14 mm on the VAS. Both inexperienced and experienced listeners were significantly less variable and showed improved interrater agreement in the anchored conditions. Anchors significantly improved agreement across groups of listeners, particularly between inexperienced and speaker-listeners.

CONCLUSION

Listeners systematically shift judgments of voice quality in response to auditory anchors. Anchors reduce interrater variability and may improve agreement across some types of listeners.

Developing the communicative participation item bank: Rasch analysis results from a spasmodic dysphonia sample

PURPOSE

The purpose of this study was to conduct the initial psychometric analyses of the Communicative Participation Item Bank-a new self-report instrument designed to measure the extent to which communication disorders interfere with communicative participation. This item bank is intended for community-dwelling adults across a range of communication disorders.

METHOD

A set of 141 candidate items was administered to 208 adults with spasmodic dysphonia. Participants rated the extent to which their condition interfered with participation in various speaking communication situations. Questionnaires were administered online or in a paper version per participant preference. Participants also completed the Voice Handicap Index (B. H. Jacobson et al., 1997) and a demographic questionnaire. Rasch analyses were conducted using Winsteps software (J. M. Linacre, 1991).

RESULTS

The results show that items functioned better when the 5-category response format was recoded to a 4-category format. After removing 8 items that did not fit the Rasch model, the remaining 133 items demonstrated strong evidence of sufficient unidimensionality, with the model accounting for 89.3% of variance. Item location values ranged from -2.73 to 2.20 logits.

CONCLUSIONS

Preliminary Rasch analyses of the Communicative Participation Item Bank show strong psychometric properties. Further testing in populations with other communication disorders is needed.