Korean Version of the Voice Activity and Participation Profile (K-VAPP): A Validation Study

Predictive Factors Affecting the Outcomes Of angiolytic Laser-Assisted Glottoplasty for Sulcus Vocalis

OBJECTIVE

Glottoplasty using an angiolytic laser is an option for the surgical treatment of sulcus vocalis. In this study, we sought to evaluate the clinical outcomes of using a 532-nm diode laser in sulcus vocalis patients and to identify predictive factors of improved voice outcomes after angiolytic laser-assisted glottoplasty.

METHODS

A total of 66 patients with sulcus vocalis who underwent laser-assisted glottoplasty with a 532-nm diode laser were included in this study.

RESULTS

3 months after surgery, GRBAS scores, patient-reported outcome measures, fundamental frequency (F0), jitter percent, and noise-to-harmonic ratio decreased significantly, while cepstral peak prominence (CPP) of vowel and sentence production increased. Patients with auditory-perceptual improvements showed greater improvement in the Voice Handicap Index (VHI) scores, F0, and CPP of vowel and sentence production compared to those with no improvement. While young male patients with preoperatively high F0 were predicted to have favorable outcomes, the type of sulcus vocalis was not predictive of treatment outcomes. Patients treated with lower laser power showed better improvement in the VHI scores postoperatively than those who received higher laser power per vocal fold. Combined injection laryngoplasty with laser glottoplasty was effective in lowering the F0, especially in male patients with high F0.

CONCLUSION

A 532-nm diode laser is useful for treating sulcus vocalis. Young male patients and individuals with preoperatively high F0 showed better voice outcomes after laser glottoplasty. Laser power and combined injection laryngoplasty are considered to affect improvement in the VHI and lowering F0 after laser glottoplasty in sulcus vocalis.

Comprehensive Index of Vocal Fatigue (CIVF): Development and Clinical Validation

OBJECTIVES

In this study, we sought to investigate whether auditory-perceptual and acoustic measures change after a passage-reading task and to develop a multidimensional index of performance fatigue in voice disorders. The clinical usefulness and cut-off scores of the newly developed index were also explored.

METHODS

A total of 150 patients (age = 35.65 ± 11.44 years) with voice disorders and 100 healthy controls (age = 35.04 ± 11.26 years) were enrolled in the study. Overall severity (OS) and acoustic measures of sentence samples were obtained before and after a passage-reading task and compared between the two positions. Acoustic features included cepstral peak prominence (CPP), σCPP, L/H spectral ratio (SR), and σSR. Using the changes (Δ) in those acoustic measures and the scores of the Vocal Fatigue Index (VFI), a predictive model of the ΔOS was established. The clinical cut-off point of the index was also identified.

RESULTS

For the patient group, OS was higher, but CPP and σCPP were lower for the rear position (after reading the passage) compared to the front position (before reading the passage). A significant portion (adjusted R² = 77.7%) of the ΔOS was predicted by ΔCPP, tiredness score of the VFI, ΔσCPP, ΔσSR, and ΔSR. The area under the curve of the newly developed index was .864 (sensitivity, 78.67%; specificity, 78.00%), and the index's criterion was >2.6489.

CONCLUSIONS

The newly developed Comprehensive Index of Vocal Fatigue (CIVF) can quantify vocal fatigue in voice disorders, reflecting both acoustic and auditory perceptual changes after a passage-reading task. Further studies should explore the responsiveness of the CIVF and the impact of related factors on the CIVF in various voice disorders.

Investigation of Validity and Reliability of Voice Activity and Participation Profile-Turkish Version (VAPP-TR)

A voice activity and participation profile (VAPP) is a self-assessment tool used to measure activity and participation limitations resulting from voice disorders. This study aims to demonstrate the adaptation, validity, and reliability of the Turkish version of the VAPP scale. A total of 231 individuals, 155 with voice disorders (patient group) and 76 without voice disorders (normal group), were included in this study. With reliability, internal consistency, and test-retest methods; validity was evaluated with criterion and convergent validity methods. The Cronbach α coefficient calculated for internal consistency was found to be 0.985 for the VAPP total and between 0.914 and 0.978 for the subsections. Intraclass Correlation Coefficient was found to be 0.974 for the VAPP total and between 0.800 and 0.981 for the subsections. Total and subsection scores of the VAPP scale had correlation coefficients ranged between 0.725 and 0.903 with VHIT and V-RQOLT in the whole sample (all P<0.001). The cut-off point was determined as ≥ 8 by ROC curve analysis for criterion validity. VAPP-TR is a valid and reliable tool that can be used to evaluate the quality of life of Turkish patients with voice disorders, particularly those with activity limitations and participation restrictions.

Reliability of Acoustic Measures in Dysphonic Patients With Glottic Insufficiency and Healthy Population: A COVID-19 Perspective

OBJECTIVES

The COVID-19 pandemic has affected the voice assessment protocols for dysphonic patients. In this study, we compared the changes in acoustic measures of the healthy population as well as dysphonic patients due to glottic insufficiency between the pandemic period requiring face masks and the prepandemic period when the masks were not essential. The clinical reliability of the acoustic measures with and without face masks was explored.

METHODS

A total of 120 patients (age = 42.3 ± 11.9 yrs) with glottic insufficiencies such as UVFP and sulcus vocalis and 40 healthy population (age = 40.5 ± 11.2 yrs) cohorts were enrolled during the pandemic period. Age- and gender-matched 120 patients and 40 healthy population cohorts who underwent voice assessment without face masks before the pandemic were enrolled as prepandemic controls. Acoustic measures and overall severity estimates of vowel and speech samples were compared, which included cepstral peak prominence (CPP), L/H spectral ratio (SR), their standard deviations, F0, jitter percent (Jitt), shimmer percent (Shim), noise-to-harmonic ratio (NHR), Cepstral Spectral Index of Dysphonia (CSID), and Acoustic Psychometric Severity Index of Dysphonia.

RESULTS

Both patients and healthy cohorts showed higher SRv and SRs but lower CSIDv during the pandemic compared to the prepandemic period. F0 of the healthy male controls during the pandemic was higher than during the prepandemic periods, while the CSIDs was lower for the pandemic period. The pandemic patient cohort showed lower σSRs compared to the prepandemic patient cohort. When the acoustic measures of patients were compared to the healthy population cohort, the patient cohort showed lower CPP and σCPPs, while higher σCPPv, Jitt, Shim, and NHR during both pandemic and prepandemic period. Overall, the area under the curve of the acoustic measures and overall severity estimates was similar between the mask and non-mask groups, although the AUC of the SR measures was poor.

CONCLUSIONS

Wearing face masks during the pandemic did not compromise the overall reliability of the acoustic analysis in patients with glottic insufficiency, suggesting the current protocol of acoustic analysis can be carried out reliably while wearing a mask to ensure safety in the pandemic era.

Care and Management of Voice Change for Thyroid Surgery: Korean Society of Laryngology, Phoniatrics and Logopedics Clinical Practice Guideline

Voice change is a common complaint after thyroid surgery and has significant impacts on quality of life. The Korean Society of Laryngology, Phoniatrics, and Logopedics set up a task force team to establish guideline recommendations on education, care, and management related to thyroid surgery. The guideline recommendations include preoperative voice education, management of anticipated voice change during surgery, and comprehensive voice care after thyroid surgery, including in-depth information and up-to-date knowledge based on validated literature. The committee constructed 14 key questions (KQ) in three categories: preoperative (KQ1-2), intraoperative (KQ 3-8), and postoperative (KQ 9-14) management and developed 18 evidence-based recommendations. The Delphi survey reached an agreement on each recommendation. Detailed evidence profiles are presented for each recommendation. The level of evidence for each recommendation is classified into high, moderate, and low-quality. The recommendation's strengths are adjusted to consider the level of evidence resulting in the recommendation and are divided into strong and weak. The guidelines are primarily targeted toward physicians who treat thyroid surgery patients and speech-language pathologists participating in patient care. These guidelines will also help primary care physicians, nurses, healthcare policymakers, and patients improve their understanding of voice changes and voice care after thyroid surgery.

GALP Qualifier Scale: Initial Considerations to Classify a Voice Problem

OBJECTIVE

To propose a single qualifier scale for voice problems based on the International Classification of Functioning, Disability, and Health (ICF) that classifies a voice problem considering its multidimensionality.

METHOD

A multicultural database was analyzed (280 subjects). The analyzed information was: the perceptual judgment of the overall voice quality (G); the acoustic analysis (A) with the Acoustic Voice Quality Index; the laryngeal diagnosis (L) and the patient self-assessment (P) using the Voice Handicap Index. The variables were categorized. A 2-step cluster analysis was performed to define groups with common characteristics.

RESULTS

A 7-point qualifier scale, the GALP, was defined to generally classify levels of voice problems considering 4 dimensions of the voice evaluation. Each level of voice problem, that is, no problem, mild, moderate, severe, or complete voice problem, has its own possible outcome for G, A, L, and P that will change, or not, the overall level of voice problem. The extremes of the scale represent "no problem" at all when all parameters are normal, and "complete problem" when all parameters are altered. The 3 levels in between were defined by the cluster analysis (mild, moderate, and severe problem) and change according to the outcome of each evaluation (G, A, L, and P). Thus, changes in one parameter alone may or not contribute to the change of the level of voice problem. Also, there are 2 categories for cases that do not fit the classification (not specified) and for which some of the variables are missing (not applicable).

CONCLUSION

The GALP scale was proposed to classify the level of voice problem. This approach considers important dimensions of voice evaluation according to the ICF. It is a potential tool to be used by different professionals, with different assessment procedures, and among different populations, clinicians, and study centers.

Psychometric Properties of Voice Activity Participation Profile-Persian Version (VAPPP)

OBJECTIVES

Individuals with voice disorders may experience limits in activity and restricted participation in daily activities. The aim of this study was to investigate the psychometric properties of the Voice Activity Participation Profile-Persian Version (VAPPP), a questionnaire which specifically investigates activity limitation and participation restriction in Persian-speaking individuals with voice disorders.

METHOD

We completed a translation procedure according to World Health Organization guidelines, prior to administering the questionnaire to 208 participants (156 patients with dysphonia and 52 controls), each of whom completed the questionnaire. We examined various psychometric properties including item analysis, factor analysis, internal consistency, discriminant validity, criterion-related validity, and test-retest reliability were investigated for this questionnaire.

RESULTS

Confirmatory factor analysis revealed that the 27 items on the VAPPP were distributed across four factors and that the first question, which assesses self-perceived dysphonia severity, was grouped separately. All the four subscales and total VAPPP have high internal consistency and test-retest reliability based on Cronbach's alpha coefficients and the intraclass correlation coefficient (ICC). Job effects (α = 0.85; ICC = 0.96), daily communication effects (α = 0.96; ICC = 0.83), social communication effects (α = 0.91; ICC = 0.93), emotional effects (α = 0.94; ICC = 0.76), and total score (α = 0.97; ICC = 0.88) are presented. VAPPP scores in patients with dysphonia were significantly different from those of the healthy control group (P < 0.001). The VAPPP total score has a high correlation to the Voice Handicap Index (r = 0.86; P < 0.001) CONCLUSION: The VAPPP is a reliable and valid tool for evaluating the quality of life of patients with dysphonia in Iran.