Cross-Cultural Adaptation and Validation of Consensus Auditory Perceptual Evaluation of Voice (CAPE-V): A Systematic Review

INTRODUCTION

Consensus Auditory Perceptual Evaluation of Voice (CAPE-V) is a widely used perceptual evaluation scale for voice assessment. It is adapted in many regional languages worldwide. This systematic review will help critically evaluate the methodologies used to adapt and establish CAPE-V as a valid and reliable tool.

METHOD

Authors reviewed literature in search engines (Scopus, Google Scholar, PubMed) to identify studies published in English between 2002-2020. The CAPE-V translated and adapted for linguistic or cultural variations were included for the review. The studies were compiled using the Mendeley Reference Manager and screened for title/abstract before shortlisting the studies.

RESULTS

The initial database had 3459 search results and after duplicates removal, 1535 articles were analysed. Thirteen studies were narrowed based on title/abstract screening. A final of ten studies were selected for the review.

DISCUSSION/CONCLUSION

This review provided a comprehensive understanding of the challenges encountered during cross-cultural adaptation and will help future researchers choose a suitable adaptation method.

Home Remedies ("Paati Vaidyam") for Voice Disorders: Some Common Practices Among School Teachers

AIM

The study aimed to document the practices followed as home remedies to treat voice-related symptoms among school teachers.

STUDY DESIGN

Cross-sectional study.

METHOD

A total of 385 school teachers from Chennai, India, participated in the study. Data were collected through six open-ended questions to elicit information about conventional remedial practices for voice-related issues. Responses from the participants were recorded and analyzed.

RESULTS

Around 88% of the teachers in the study preferred to adhere to home remedies as their first treatment of choice when encountering a voice problem. A few of the reported home remedies were simple preparations using turmeric (Curcuma longa), ginger (Zingiber officinale), honey, sugar palm (Arenga pinnata), rock candy, mint (Mentha piperita), and cumin seeds (Cuminum cyminum), taken in singly or in combinations. The study also noted specific remedies for a range of vocal symptoms such as throat pain, irritation, or voice tiredness as per the belief systems of people speaking Tamil.

DISCUSSION/CONCLUSION

Home remedies, also known, as "Paati Vaidyam," are commonly used by Indian households to address health problems, including voice-related issues. The study indicated the prevalence and popularity of using home remedies for voice-related issues among teachers. The scientific logic or utility of these practices was explored in this study based on available information in voice literature. The information obtained is valuable for counseling (explaining local practice methods and available evidence) and education, keeping in mind the belief system, and practice methods of Tamils while imparting vocal hygiene education to the teachers.

An eclectic Voice Therapy Program for the Treatment of Hyperfunctional Voice Disorders (HFVD)

PURPOSE

An eclectic voice therapy program includes sequenced and structured set of exercises combining direct and indirect intervention methods. Tailor-made exercise prescription with specific cultural adaptations are needed to provide a holistic change to voice quality.1 This study detailed the construction of an exercise prescription for participants with hyperfunctional voice disorder [HFVD] in the Indian context.

METHOD

The exercise program was developed based on literature related to vocal therapy approaches and delivery methods. Adaptations were introduced to a selected set of exercises. Five voice experts verified the exercises and their prescription for content and feasibility of use in the Indian context. Modification suggested by the experts were included for framing the final version of the exercise program. This structured therapy program was planned for 6 weeks (30 minutes duration/session offered individually twice per week, with a gap of two days between sessions in a week) with the goals to improve voice quality, flexibility, and endurance while speaking. Five participants with HFVD partook in the study for pilot testing. Stroboscopy, perceptual voice analysis, Dysphonia Severity Index (DSI) and Vocal Fatigue Index in Tamil (VFI-T) were used to report the therapy outcomes. Participants' report on the learning process and generalization of the program were documented. Wilcoxon-signed rank test was used to test the pre-post outcome measures.

RESULTS

An eclectic voice therapy program, i.e., Comprehensive Voice Habilitation Program [CVHP] was constructed and it included vocal hygiene instructions, warm-up & cool-down, easy onset, resonant voice, and carry over exercises. Participants completed the program in 14-18 sessions (over 7 to 9 weeks of therapy). All participants showed significant changes in vocal fold movement patterns, reduction in ventricular hyperadduction, overall grade of voice quality, DSI and VFI-T. Participants reported that pictorial illustrations, feedback, and monitoring sheets were useful in learning the exercises.

CONCLUSION

CVHP showed significant change in the voice-related outcome measures and was a viable program for treating HFVD.

Joint Engagement in Mother-Child Dyads of Autistic and Non-Autistic Children Among Asian Indian Tamil Speaking Families

This study profiled various levels of engagement and related communication behaviours among 50 Asian Indian Tamil autistic children (AUT) and their mothers. The interaction was compared with two groups of mother-child dyads of non-autistic (NA) children, 50 in each group, matched for chronological age (CA), and for language level (LL). Results indicated that despite mother's efforts to engage with their children, autistic children were often 'engaged with objects' or remained 'unengaged' due to children's preference for solitary play, while NA children were often engaged in 'co-ordinated' and 'people engagement'. Across the three groups, mothers predominantly took the lead and dominated the interaction, irrespective of children's language levels. These initiations by the mothers were often to provide instructions and to ask 'What' questions. Autistic children initiated communication predominantly to ask for an object and responded often in the form of negations and protests with limited verbal output or non-verbally. Most of the communication behaviours of both children and mothers in AUT group was quantitatively and qualitatively different when compared to those in both the NA groups, indicating unique nature of interactions despite matching for CA or LL. The observations from the study highlights the need for considering adult's contingent behaviours also, while assessing communication skills of autistic children in order to provide effective intervention.

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.

Development and Validation of Sentences in Tamil for Psychoacoustic Evaluation of Voice Using the Consensus Auditory-Perceptual Evaluation of Voice

PURPOSE

The Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) is a standardized instrument used in voice assessment to assess voice quality. It has been translated and culturally adapted in several languages. This study aimed at developing and validating a Tamil version of CAPE-V through auditory perceptual evaluation of remotely recorded voice samples.

METHOD

The Tamil version was adapted with permission from the American Speech-Language-Hearing Association to match the rationale in English CAPE-V. The sentences were constructed by the first author and validated for content by two panels of experts. Forty-five participants (15 cases and 30 controls) were included in the study. Data recording was conducted online (Zoom Video Communications, Inc., app) for all samples. Three raters participated in the auditory evaluation and scored all samples using Grade, Roughness, Breathiness, Asthenia, and Strain (GRBAS) scale followed by CAPE-V with a week gap in between. Twenty percent of samples were repeated to assess intrarater reliability. The intrarater and interrater reliability measures for Tamil CAPE-V were established using intraclass coefficients (ICCs). To ensure construct validity, group differences were determined between the cases and controls. The concurrent validity was established by correlating Tamil CAPE-V with the GRBAS scale.

RESULTS

The intrarater reliability for Tamil CAPE-V ranged from moderate to excellent (ICC: .610-.998). The Tamil CAPE-V obtained moderate to good interrater reliability for all parameters (ICC: .525-.790) except pitch (ICC: .405). The differences between the cases and controls were statistically significant (p < .01). The correlation between CAPE-V and GRBAS was strong for overall severity, breathiness, and strain (r _s = .725-.861) and moderate for roughness (r _s = .678).

CONCLUSION

The Tamil CAPE-V is a reliable and valid tool for auditory perceptual evaluation in Tamil-speaking populations.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21513885.

Acoustic Description of Bhramari Pranayama

The study's aim was (1) To describe the acoustic characteristics of Bhramari pranayama, and (2) to compare the acoustic features of nasal consonant /m/ and the sound of Bhramari pranayama produced by yoga trainers. Cross-sectional study design. Thirty-three adult male yoga trainers performed five repeats of nasal consonant /m/ and Bhramari pranayama. These samples were recorded into Computerized Speech Lab, Kay Pentax model 4500b using a microphone (SM48). Formant frequencies (f F1, f F2, f F3, & f F4), formant bandwidths (BF1, BF2, BF3, & BF4), anti-formant, alpha and beta ratio were analyzed. Nasal consonant /m/ had higher f F2 and anti-formant compared to Bhramari pranayama. Statistical significant differences were noted in f F2, BF3, and anti-formants. Bhramari pranayama revealed a low alpha ratio and a higher beta ratio than /m/. However, these differences were not statistically significant. Findings are discussed from acoustic and physiological perspectives. Bhramari pranayama was assumed to be produced with a larger pharyngeal cavity and narrower velar passage when compared to nasal consonant /m/. Verification at the level of the glottis and with aerodynamic parameters may ascertain the above propositions.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-021-03054-1.

Performance of a Closed Set Picture Identification Test in Tamil for Children with Cochlear Implant

The study attempted to assess the closed set word identification abilities in children with cochlear implant (CI) with a picture identification test developed in Tamil. The test was validated on typically developing children with normal hearing (NH) to build a reference for comparison. Participants for the study included 205 children with NH between the age range of 3-6 years and 45 children with cochlear implant within the age range of 3-11 years. The picture identification test was developed using bisyllabic words with corresponding pictures in Tamil. Two lists were created with 25 words each and administered to the children with NH and CI. The scores of both the groups were analysed. The results indicated that the mean scores improved as age increased for children in the NH group. Also, there was no significant difference in performance between the two-word lists. Significant difference in scores was noted between the CI and the NH group (p < 0.01). However, the mean scores in the CI group increased as the experience with CI increased. The picture identification test in Tamil is deemed appropriate to elicit closed set word identification responses for children with CI between the age of 3-6 years. The test will provide supplemental information for mapping and to plan habilitation for children with CI.

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.

Trends in Performance Using Early Speech Perception Test in Typically Developing Tamil-Speaking Children

Background and Objectives

The study attempted to trace age-related changes in speech perception in typically developing children (≥3 to ≤6 years) using the “Early Speech Perception (ESP)” in Tamil. The test was developed in line with the original English version of ESP but adapted to suit the linguistic requirement of the Tamil language.

Subjects and Methods

Using a cross-sectional design, the test was administered to 205 children with normal hearing who were classified into three age groups (≥3 to ≤4, >4 to ≤5, and >5 to ≤6 years). The developed test had three subtests (syllable categorization, bisyllable word identification, and trisyllable word identification).

Results

All three age groups obtained perfect or near-perfect scores on the three subtests of ESP. There was no significant difference observed between the two adjacent age groups (≥3 to ≤4 vs. >4 to ≤5 years, >4 to ≤5 vs. >5 to ≤6 years) for all three subtests. However, significant differences were seen only between the youngest and the oldest age groups for the three subtests (≥3 to ≤4 vs. >5 to ≤6 years).

Conclusions

The results indicated that ESP in Tamil can be performed effectively in all the three age groups studied.

Comparison of Client-Led Asynchronous and Clinician-Led Synchronous Online Methods for Evaluation of Subjective Vocal Measures in Teachers: A Feasibility Study

BACKGROUND

COVID-19 has transformed face to face teaching in classrooms to online and hybrid modes. Increased vocal intensity/ pitch to call attention of students and transact in the online class, inappropriate posture (head, neck & upper trunk) while using the laptop and other online tools cause vocal loading leading to voice related concerns in teachers. Tele voice assessment is a feasible alternative means to seek professional help in the current situation and possibly in the future too. Client-led asynchronous and clinician-led synchronous voice recordings for clinical vocal measures among school teachers were compared in this study.

METHOD

Twenty-five school teachers (21 females & four males) from Chennai consented to the study. Information of voice use, its impact on the day-to-day situations, self-perception of vocal fatigue, and their recorded voice sample (phonation & speaking) were obtained online (asynchronous mode). Within a period of ten days, the clinician-led synchronous session was planned on a mutually convenient time for obtaining voice samples through zoom call. The voice samples obtained were compared for clinical measures and perceptual voice evaluation.

RESULTS

Participants reported of vocal symptoms and increased vocal fatigue scores. The maximum phonation time values obtained through synchronous mode were lesser when compared to asynchronous mode. Also, variability was noted in the perceptual vocal measures of voice samples obtained through synchronous mode. During synchronous voice recording & evaluation, the background noise, internet stability, audio enhancement feature, and microphone placement & quality could be monitored, and immediate feedback was provided. Additionally, the asynchronous recording can be supplemented for synchronous recording, with clear instructions & demonstration.

CONCLUSION

This study explored the feasibility of using synchronous and asynchronous voice recording for voice analysis in school teachers. The findings could serve as a base to understand the advantages and challenges of using client-led asynchronous and clinician-led synchronous methods for estimating vocal measures.

Relationship between parental report of language skills and children's performance among 3-year-olds: Implications for screening language among preschoolers

AIM

The study compared parental ratings of children's language abilities at 3-years of age with observations of children's language performance by Speech Language Pathologists (SLPs).

METHOD

Children (n=85) around 3-years of age were recruited from a child development clinic. Detailed speech and language assessments were completed during a one-hour semi-structured clinician-child interactive session. Language assessment was carried out using a criterion-referenced checklist and the language sections of the Bayley Scale for Infant Development- 3rd Edition (BSID-III). All parents rated their children's language skills using seven statements related to reception and expression domains of language on a 7-point rating scale. The language status of the child (typical language vs delay) determined by the parental report was matched with the language status as per the child's performance during the SLP assessment.

RESULTS AND DISCUSSION

Mean parental ratings of children assessed as having language delay by an SLP were significantly lower than children with typical language. Total parental rating score correlated highly with overall language scores on BSID-III; the highest correlation was observed for ratings of statements related to expressive language skills focusing on formation of sentences. Parental report of below normal performance on any one of the seven statements demonstrated acceptable sensitivity (0.95) and a high negative predictive value (0.98) with the child's performance as the gold standard.

CONCLUSION

Parental ratings of language skills correlated with child's performance at 3-years of age with a higher agreement for identifying children with delays. Parental reports can be useful to red-flag children for further assessment and continued monitoring of language development in busy developmental clinics and preschools, especially in the context of low-resource settings.

Distortion product otoacoustic emissions in very preterm infants: A longitudinal study

BACKGROUND

Very preterm infants are at a greater risk of developing neurodevelopmental impairments such as neuro-motor delays, vision and hearing deficits (Roze and Breart, 2004; Saigal and Doyle, 2008) [1,2]. The hearing difficulties in preterm infants vary depending on the co-morbid conditions. However, prematurity itself is considered as a risk factor that influence the functioning of auditory system.

AIM

The current study aims to compare the DPOAEs in very preterm infants and term infants at 1 month, 3 months and 6 months of age (corrected age in preterm infants).

METHOD

DPOAEs were recorded in 72 very preterm infants and 30 term infants at 1 month, 3 months and 6 months of age. All these infants had obtained 'pass' results in newborn hearing screening using ABR. DPOAE f2 test frequency was measured at six frequencies (1500 Hz, 2000 Hz, 3000 Hz, 4500 Hz, 6000 Hz and 8000 Hz) with primary tone stimulus intensity L1 equal to 65 dBSPL and L2 equal to 55 dBSPL with primary tone f2/f1 frequency ratio of 1.2. Otoscopic examination and tympanometry was performed prior to DPOAE testing, to ascertain normal middle ear status.

RESULTS

DPOAE amplitude did not change significantly between two groups from 1 month till 6 months of age (p > 0.05). DPOAE amplitude and noise floor in very preterm infants were not different from term infants and DPOAE amplitude did not vary significantly across f2 frequencies at various time periods.

CONCLUSION

The current study findings provided evidence that prematurity did not constitute as a factor to influence the results of DPOAE in very preterm infants who passed newborn hearing screening test. Any significant reduction in DPOAE amplitude or absence of DPOAE in very preterm infants has to be considered and monitored effectively, as it may not reflect a developmental process of cochlear function; instead it could indicate the presence of inner ear or middle ear pathology.

Frequency Range Measures in Carnatic Singers

BACKGROUND

Frequency range measures in singers reflect their physiological capacity, vocal flexibility, training effects, strengths, and limitations in singing. Since this information is vital for pedagogic and clinical purposes, this study aimed to measure the frequency range in Carnatic singers while singing different aspects of the vocal music.

METHOD

Practice task (gliding from lowest to highest note) and performance task (singing a song with vocal ornaments) were recorded from 55 trained Carnatic singers (40 females and 15 males). The auditorily verified portions of various vocal ornaments in Carnatic singing (such as aalapanai, pallavi, anupallavi, charanam, and niraval) were coded as separate tokens. A total of 385 tokens were analyzed using PRAAT software for estimating frequency range in semitones during practice task (SFR_prac) and performance task (SFR_perf). Descriptive, ANOVA, Tukey HSD, independent t, and Mann-Whitney U were used for statistical analysis.

RESULTS

SFR_prac was higher than SFR_perf in Carnatic singers. During practice, singers explored their physiological range to improve their vocal ability. However, during performance they tend to maintain a comfortable singing range to have a flawless rendition. Aalapanai (most creative portion) had the highest frequency range (females: 22.96 ST, males: 24.57 ST) than other types of vocal ornaments in performance signing. Practice frequency range (SFR_prac) and performance frequency range (SFR_perf) were not statistically different across male and female singers.

CONCLUSION

This study described the frequency range measures in various aspects and nuances of Carnatic singing. Its clinical and pedagogic importance are discussed.

Cultural and Linguistic Adaptation of Vocal Fatigue Index for Tamil-Speaking Population (VFI-T)

OBJECTIVE

To adapt the vocal fatigue index (VFI) for the Tamil-speaking population.

STUDY DESIGN

Cross-sectional research design METHOD: VFI developed originally in English was translated in the Tamil language, a South Indian Dravidian language. Content validity and reverse translation of VFI in Tamil [VFI-T] was done. The final of VFI-T was administered on 251 subjects with voice concerns/ problems and on 100 individuals with perceptually normal voice for validity and reliability measures.

RESULTS

Factor analysis of VFI-T yielded four factors as opposed to three factors in the English version of VFI. The four factors were extracted based on Eigenvalue and variance contributed by each factor namely, I-physical discomfort; II-tiredness of voice and avoidance of voice use; III-increased effort and its effect on voice quality, and IV-Improvement of symptoms with rest. Varimax rotation and factor loading values for individual items identified five items under factor I; seven items under factor II; four items under factor III, and three items were preserved under factor IV. Overall Cronbach's alpha coefficient was 0.91 and alpha values for four factors ranged from 0.75 to 0.85. Item-to-total correlation revealed good internal consistency between the items. The median and interquartile range of VFI-T for cases and controls were viz., I-6.00 (10.00); 0.00 (1.00), factor II-12.00 (11.00); 1.00 (3.00), factor III-7.00 (8.00); 1.00 (2.00), and factor IV-6.00 (6.00); 1.00 (3.00), respectively. Mann-Whitney U test revealed a significant difference between the scores of cases and controls (P < 0.00). Logistic regression suggested sensitivity of 96% and a specificity of 79% for the inventory in the Tamil language.

CONCLUSION

VFI-T identified and documented vocal fatigue under four factors in subjects with voice disorders.

Changes in Auditory Brainstem Response in very preterm and late preterm infants

AIM

Aim of this study was to compare the absolute and interpeak latencies of Auditory Brainstem Responses (ABR) in very preterm and late preterm infants at 1 month and 3 months of corrected age.

METHOD

ology: ABR traces were obtained from 80 preterm infants (40 very preterm and 40 late preterm) at 1 month and 3 months of corrected age in a prospective, comparative cohort study. Auditory click stimuli at 70 dBnHL and 30 dBnHL, with repetition rate of 11.1/s were used. Absolute latencies of peak I, III, V and interpeak latencies of peak I-V, I-III and III-V were analyzed and compared between preterm groups at 1 month and 3 months of corrected age. Wilcoxon Signed Ranks test was used to compare the ABR variables. Mann Whitney test was used to make inferences between groups.

RESULTS

There was a statistically significant difference in absolute latencies and interpeak latencies between very preterm and late preterm infants at 1 month of corrected age (p < 0.05). Absolute latency of peak I was similar among both groups of preterms. Absolute latencies of peak III, V and interpeak latencies I-III, III-V and I-V were prolonged in very preterm infants at 1 month of corrected age. However, these latencies were significantly reduced at 3 months of corrected age. This indicated accelerated maturation/myelination of the central auditory nervous system in very preterm infants. Absolute latencies of peak III and V and interpeak interval I-V was reduced in late preterm infants at 3 months of corrected age and this was statistically significant. This reduction in latency was considered to be a normal age dependent change.

CONCLUSION

Findings of the current study revealed that there was no deviation in the pattern of auditory maturation among preterms; it followed the typical 'caudal to rostral' form of maturation. Very preterm infants have less mature neuronal development compared with late preterm infants at 1 month of corrected age which catches up at 3 months of corrected age.

Vocal Health Practices Among School Teachers: A Study From Chennai, India

INTRODUCTION

A healthy vocal system is a prerequisite to produce a serviceable voice for any vocal profession. The concept of vocal health (VH) among teachers is worth exploring considering their known risk of developing voice disorders.

AIM

To provide socioculture-specific information on VH practices and nature of voice problems in teachers.

METHOD

A VH questionnaire was developed to elicit opinions toward one's own voice health and factors that indicated and contributed to impaired/poor VH from 384 school teachers.

RESULTS AND DISCUSSION

'Flexible voice' (23%), 'enduring voice' (22%), and 'good voice' (22%) were descriptions to indicate good VH by teachers. 'Vocal fatigue' (13%), 'dry throat' (9.4%), 'throat irritation' (4.7%), and 'pain while swallowing/speaking' (3.1%) were frequently reported throat sensations to indicate poor VH. For 30.2% of the teachers, voice mattered for professional needs. However, most of them managed to cope with voice problems through several home remedies and 'intentional/self-imposed neglect' despite their vocal difficulties. Sociocultural factors influencing these findings and scope to escalate voice problems in teachers as a public health issue are discussed.

CONCLUSION AND IMPLICATION

Insight and perception of VH based on self-reports and information on voice practices among teachers pertinent to this geographical location provide scope to develop models for counseling and preventive treatment for voice problems.

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.

Multi parametric voice assessment: sri ramachandra university protocol

Emergence of "Voice specialty clinics" in ENT and Speech Language Pathologist (SLP) practice in India necessitates development of standard protocols for assessment and management of voice disorders. Based on recommendations from European Laryngological Society in Dejonckere (Eur Arch Otorhinolaryngol 258:77-82, 2001), a comprehensive voice assessment protocol was adapted for Indian population. This study aimed at verifying the face validity and feasibility of using the developed voice assessment protocol in a multi specialty tertiary care hospital. It included: history, clinical examination, visual analysis, perceptual analysis, aerodynamic measures, acoustic analysis and patients' self assessment of voice. The developed protocol was administered on 200 patients with voice concerns and problems. Correlation of self assessment with the assessment by the professionals was done using Kendaul tau_b correlation test. The scores of self assessment did not correlate significantly with acoustic measures. Differences in lab findings and self percept of voice indicated that these two were complementary measures in the protocol. Further, diagnosis and management decisions were arrived through a consensus discussion involving the ENT surgeon, SLP and the patient. Vocal hygiene and voice conservation were advised to all patients. Recommendations for voice therapy and/or surgery were provided based on findings from the protocol. The study demonstrated feasibility of using a comprehensive protocol for effective documentation, comparisons, review, training and treatment planning.

Stroboscopic and Multiparametric Acoustic Analysis of Voice after Vocal Loading Task

Introduction

Voice overuse may result in roughness, fatigue and pain while speaking. Vocal loading tasks have been used to assess changes in voice quality under different controlled settings. This study was done to document changes in voice characteristics before, immediately and 24 hours post-vocal loading task (VLT) using stroboscopic and acoustic analysis.

Materials and methods

Ten healthy adult males (age range: 20 to 40 years) with no apparent comorbid illness participated in the study. They were instructed to read the standard Rainbow passage at intensity above 75 dB SPL until they perceived any symptoms of fatigue/ strain. Stroboscopy and comprehensive voice assessment were done on all subjects before, immediate post VLT and 24 hours post VLT.

Results

Symptoms of vocal fatigue were noted on an average of 45 minutes of loud reading. Vocal fold edema, ventricular band hyperadduction and arytenoid congestion were noticed in immediate post task. The vocal fold movements were asymmetric and aperiodic with reduced mucosal wave and amplitude. Maximum phonation time (MPT) revealed statistically significant decrease (approximately 7 sec). Multiparametric acoustic analysis revealed a statistically significant increase in fundamental frequency, perturbation measures and lowest intensity with significant decrease in dysphonia severity index (DSI). All parameters (stroboscopic findings, perceptual, aerodynamic and acoustic analysis) showed values within normal limits after 24 hours post-task indicating recovery at 24 hours after vocal loading. Stroboscopy served as an evidence for structural and functional changes in the vocal fold. Changes in voice characteristics and recovery following vocal loading task can be documented using comprehensive voice assessment.

Long term transcript accumulation during the development of dehydration adaptation in Cicer arietinum

Cool season crops face intermittent drought. Exposure to drought and other abiotic stresses is known to increase tolerance of the plants against subsequent exposure to such stresses. Storage of environmental signals is also proposed. Preexposure to a dehydration shock improved adaptive response during subsequent dehydration treatment in a cool season crop chickpea (Cicer arietinum). We have identified 101 dehydration-inducible transcripts of chickpea by repetitive rounds of cDNA subtraction; differential DNA-array hybridization followed by northern-blot analysis and analyzed their responses to exogenous application of abscisic acid (ABA). Steady-state expression levels of the dehydration-induced transcripts were monitored during the recovery period between 2 consecutive dehydration stresses. Seven of them maintained more than 3-fold of expression after 24 h and more than 2-fold of expression level even at 72 h after the removal of stress. Noticeably, all of them were inducible by exogenous ABA treatment. When the seedlings were subjected to recover similarly after an exposure to exogenous ABA, the steady-state abundances of 6 of them followed totally different kinetics returning to basal level expression within 24 h. This observation indicated a correlation between the longer period of abundance of those transcripts in the recovery period and improved adaptation of the plants to subsequent dehydration stress and suggested that both ABA-dependent and -independent mechanisms are involved in the maintenance of the messages from the previous stress experience.