Surveying Colombian Speech-Language Pathologists on their Reported Training & Practices of Auditory-Perceptual Evaluation of Voice

Objective: To explore the training and use of auditory perceptual evaluation of the voice reported by Colombian speech-language pathologists. Study Design: Cross-sectional observational research with a quantitative approach. Methods: A digital questionnaire was designed and distributed to gather information regarding professionals' training process and implementation of auditory-perceptual evaluation procedures. Descriptive statistics were applied, and several generalized linear models were adjusted to determine the influence of certain variables on others. Results: The survey received responses from 40 speech-language pathologists, revealing that the most used scales for training and evaluating vocal quality within this group are direct magnitude estimations (82.5% and 77.5%). Similarly, in this group, the tasks most frequently used to train and use as an evaluation strategy are vowel assessments (38%) followed by spontaneous speech (30%). Practitioners of this group were mostly trained using a conceptual framework involving multiple exposures to rating (42.5%). The use of direct magnitude estimation in training with a normal voice showed significance (p = 0.015), as did the use of the vowel /i/ in training with an equal-appearing interval (p = 0.013). The statistical models relating the scale used to the scale on which participants were trained were also significant (p < 0.05). Conclusions: The GRBAS scale is the training tool most used by the group of speech-language pathologists of the study group in Colombia. Future efforts should focus on improving training practices for auditory-perceptual evaluation, exploring alternative conceptual frameworks, and incorporating external references to enhance validity and reliability.

Objetivo: Explorar los reportes de fonoaudiólogos colombianos acerca del entrenamiento y uso de la evaluación perceptual auditiva de la voz. Diseño de estudio: Se eligió un diseño de investigación observacional transversal con un enfoque cuantitativo. Metodología: Se diseñó y distribuyó un cuestionario digital para recopilar información sobre el proceso de formación de los profesionales y la implementación de procedimientos de evaluación perceptual auditiva. Se aplicaron estadísticas descriptivas y se ajustaron varios modelos lineales generalizados para determinar la influencia de ciertas variables en otras. Resultados: La encuesta recibió respuestas de 40 fonoaudiólogos, revelando que las escalas más utilizadas para la formación y la evaluación de la calidad vocal en el grupo son las estimaciones de magnitud directa (82.5% y 77.5%). Del mismo modo, en este grupo las tareas más frecuentemente utilizadas para la formación y el uso como estrategia de evaluación son las vocales (38%), seguidas por el habla espontánea (30%). La mayoría de los profesionales del grupo fueron formados utilizando un marco conceptual que involucra múltiples exposiciones a la calificación (42.5%). El uso de la estimación de magnitud directa en la formación con una voz normal mostró significancia (p = 0.015), al igual que el uso de la vocal /i/ en la formación con intervalos de igual apariencia (p = 0.013). Los modelos estadísticos que relacionan la escala utilizada con la escala en la que los participantes fueron entrenados también fueron significativos (p < 0.05). Conclusiones: La escala GRBAS es la herramienta de formación más utilizada por el grupo de fonoaudiólogos del estudio. Los esfuerzos futuros deberían centrarse en mejorar las prácticas de formación para la evaluación perceptual auditiva, explorar marcos conceptuales alternativos e incorporar referencias externas para mejorar la validez y la confiabilidad.

Outcomes of a Community of Practice on Quebec Speech Language Pathologists' Voice Assessment Practices and Professional Identity

In a context where different protocols for recommended practices in clinical voice assessment exist, while there are gaps in the literature regarding the evidence base supporting assessment procedures and measures, clinicians from regions where a strong community holding expertise in clinical and scientific voice practices lack can struggle to confidently develop their voice assessment practices. In an effort to improve voice assessment practices and strengthen professional identity among speech-language pathologists in Quebec, Canada, a community of practice (CoP) was established, with the aim of promoting knowledge sharing, implementing change in clinical practice, and improving professional identity. Thirty-nine participants took part in the CoP activities conducted over a four-month period, including virtual meetings and in-person workshops. Participants had a high rate of attendance (> 74% participation rate in virtual meetings), and were highly satisfied with their participation and intended to remain involved after the project's end. Statistically significant changes in voice assessment practices were observed post-CoP, regarding probability of performing assessments (p < .001), and perceived importance of assessment for evaluative purposes (p <.001), as well as improvements in assessment specific confidence, specifically for procedure of auditory-perceptual assessment (p < .001) and purpose of aerodynamic assessment (p = .05). Moreover, there was an increase in professional identity post-CoP (p < .001) and participants felt they made significant learnings. The present study highlighted the need to involve SLPs in future research to identify assessments that are relevant to the specific evaluative objectives of SLPs working with voice, and suggests CoPs are an efficient tool for that purpose.

En un contexto en el que existen diferentes protocolos para las prácticas recomendadas en la evaluación vocal clínica, y en el que se presentan vacíos en la literatura respecto a la base de evidencia que respalda los procedimientos y medidas de evaluación, los profesionales de regiones donde no hay una comunidad sólida con experiencia en prácticas vocales clínicas y científicas pueden enfrentar dificultades para desarrollar con confianza sus prácticas de evaluación vocal. Con el propósito de mejorar las prácticas de evaluación vocal y fortalecer la identidad profesional entre los logopedas de Quebec, Canadá, se estableció una comunidad de práctica (CdP). Esta tenía como objetivo fomentar el intercambio de conocimientos, implementar cambios en la práctica clínica y mejorar la identidad profesional. Un total de treinta y nueve participantes se involucraron en las actividades de la CdP, llevadas a cabo durante un período de cuatro meses, que incluyeron reuniones virtuales y talleres presenciales. Los participantes tuvieron una alta tasa de asistencia (> 74% de participación en las reuniones virtuales) y expresaron un alto grado de satisfacción con su participación, manifestando su intención de continuar involucrados después de la finalización del proyecto. Se observaron cambios estadísticamente significativos en las prácticas de evaluación vocal posterior a la CdP, en lo que respecta a la probabilidad de llevar a cabo evaluaciones (p < .001) y la percepción de la importancia de la evaluación con fines evaluativos (p < .001), así como mejoras en la confianza específica en la evaluación, particularmente en el procedimiento de evaluación auditivo-perceptual (p < .001) y el propósito de la evaluación aerodinámica (p = .05). Además, se registró un aumento en la identidad profesional posterior a la CdP (p < .001) y los participantes sintieron que obtuvieron aprendizajes significativos. El presente estudio destacó la necesidad de involucrar a los logopedas en investigaciones futuras, para identificar evaluaciones pertinentes a los objetivos evaluativos específicos de los logopedas que trabajan con la voz, y sugiere que las CdP son una herramienta eficiente con ese propósito.

Preliminary analysis of the effect of individualized voice therapy on pediatric voice disorders / 临床耳鼻咽喉头颈外科杂志

Objective:To determine the effectiveness of individualized voice therapy in persistent pediatric voice disorders. Methods:Thirty-eight children who were admitted to the Department of Pediatric Otolaryngology Shenzhen Hospital, Southern Medical University due to persistent voice disorder from November 2021 to October 2022 were included. All children were evaluated by dynamic laryngoscopy before voice therapy. Two voice doctors performed GRBAS score and acoustic analysis on the children's voice samples to obtain the relevant parameters including F0, Jitter, Shimmer, and MPT; All children were given personalized voice therapy for 8 weeks. Results:Among 38 children with voice disorders, 75.8%（29 cases） were diagnosed with vocal nodules, 20.6%（8 cases） were vocal polyps, and 3.4%（1 case） were vocal cysts. And in all children. And 51.7%（20 cases） had the sign of supraglottic extrusion under dynamic laryngoscopy. GRBAS scores decreased from 1.93 ± 0.62, 1.82 ± 0.55, 0.98 ± 0.54, 0.65 ± 0.48, 1.05 ± 0.52 to 0.62 ± 0.60, 0.58 ± 0.53, 0.32 ± 0.40, 0.22 ± 0.36, 0.37 ± 0.36. F0, Jitter, Shimmer decreased from（243.11±39.73） Hz, （0.85±0.99）%, （9.96±3.78）% to（225.43±43.20） Hz, （0.33±0.57）%, （7.72±4.32）%, respectively MPT was prolonged from（5.82±2.30） s to（7.87±3.21） s after treatment. All parameters changes had statistical significance. Conclusion:Voice therapy can solve children's voice problems, improve their voice quality and effectively treat children's voice disorders.

Auditory-vocal integration impairment: New challenges and opportunities for voice assessment and therapy / Alteración de la integración auditivo-vocal: nuevos retos y oportunidades para la evaluación y la terapia de la voz

This reflection paper addresses the importance of the interaction between voice perception and voice production, emphasizing the processes of auditory-vocal in-tegration that are not yet widely reported in the context of voice clinicians. Given the above, this article seeks to 1) highlight the important link between voice pro-duction and voice perception and 2) consider whether this relationship might be exploited clinically for diagnostic purposes and therapeutic benefit. Existing theories on speech production and its interaction with auditory perception provide context for discussing why the evaluation of auditory-vocal processes could help identify associ-ated origins of dysphonia and inform the clinician around appropriate management strategies. Incorporating auditory-vocal integration assessment through sensorimotor adaptation paradigm testing could prove to be an important addition to voice assess-ment protocols at the clinical level. Further, if future studies can specify the means to manipulate and enhance a person's auditory-vocal integration, the efficiency of voice therapy could be increased, leading to improved quality of life for people with voice disorders

Este artículo de reflexión aborda la importancia de la interacción entre la percepción y la producción de la voz, haciendo hincapié en los procesos de integración auditivo-vocal, los cuales aún no han sido muy divulgados en el contexto de los clínicos de voz. Dado lo anterior, este articulo busca: 1) destacar la importante relación entre la producción y la percepción de la voz y 2) considerar si esta relación pudiese explotarse clínicamente con fines diagnósticos y terapéuticos. Las teorías existentes sobre la producción de la voz y su interacción con la percepción auditiva proporcionan el contexto para discutir por qué la evaluación de los procesos auditivo-vocales podría ayudar a identificar los orígenes asociados a cierto tipo de disfonías e informar al clínico sobre las estrategias de abordaje adecuadas. La incorporación de la evaluación de la integración auditivo-vocal a través de la prueba del paradigma de adaptación sensoriomotora podría ser una importante adición a los protocolos de evaluación de la voz a nivel clínico. Además, si los estudios futuros pueden especificar los medios para manipular y mejorar la integración auditivo-vocal de una persona, la eficacia de la terapia de la voz podría aumentar, lo que llevaría a mejorar la calidad de vida de las personas con trastornos de la voz

Effects of adult cleft palate surgery combined with pharyngoplasty / 口腔疾病防治

Objective@#To assess the voice recoverment of pharynplasty given at the same time with the velopharyngeal closure surgery.@*Methods@#36 cases of cleft palate patients aged 18-32 years were divided into control group (18 cases) and experimental group (18 cases). Only cleft palate surgery was given in the control group, while pharyngoplasty combined with the palate closure surgery were given in the experimental group. Wound healing assessment were performed after 1 week , and voice improvement were compared in the 2 groups after 3 months.@*Results@#Well wound healings without any infections were achieved in all the cases, except for 1 case had a palate dehiscence 1 week after the operation. Dysarthria and nasal leak were improved significantly in the experiment group (P < 0.05), however the nasal resonance improvement between the 2 groups were not significantly different (P > 0.05).@*Conclusion@#Adult cleft palate surgery combined with the pharyngeal angioplasty is a recommended method.

Uso del análisis acústico en el seguimiento de pacientes con patología vocal: estudio preliminar / Use of acoustic analysis in patients with voice pathologyfollow-up: a preliminary study / Uso da análise acústica no seguimento de pacientes compatologia vocal: estudo preliminar

Introducción: la evaluación vocal es multiparamétrica. En la dimensión acústica, los índices de perturbación y la relación armónico-ruido han sido cuestionados. La espectrografía acústica permite realizar representaciones visuales de la voz. El propósito de este trabajo es analizar si los índices de perturbación y la relación armónico-ruido mejoran en pacientes que presentaron una buena evolución vocal y describir la utilidad del espectrograma de banda angosta. Material y método: Estudio retrospectivo de una serie de casos. Se realizaron evaluaciones perceptuales y se obtuvieron informes otorrinolaringológicos pre y post-tratamiento en pacientes que presentaron buena evolución vocal post-tratamiento. Se grabó una vocal /a/ sostenida. Se analizaron los índices de perturbación y armónico-ruido generando un espectrograma de banda angosta. Resultados: Se incluyeron ocho pacientes entre 10 y 62 años. El jitter mejoró en cinco pacientes, el shimmer en siete y el armónico–ruido en la totalidad. El promedio mejoró en todos los parámetros estudiados luego del tratamiento. La diferencia pre y post-tratamiento no resultó significativa. En el espectrograma de banda angosta se observó mejor definición de la estructura armónica y disminución del componente de ruido en todos los casos. Conclusiones: Cuatro de los ocho pacientes presentaron evolución favorable en todos los parámetros. El promedio de los índices de perturbación y armónico-ruido fue mejor luego del tratamiento, si bien la diferencia encontrada no fue significativa. El espectrograma de banda angosta es un complemento que permitiría mejorar la interpretación de los índices de perturbación y armónico-ruido dentro de una evaluación vocal multidimensional y multiparamétrica.

Introduction: voice assessment is multiparametrical. In the acoustic dimension, the perturbation measures and the harmonics-to-noise ratio have been questioned. Sound spectrography allows visual representations of voice. The purpose of this paper is to analyze if perturbation measures and harmonics-to-noise ratio improve in a group of patients who showed good vocal evolution and to describe narrow band spectrogram usefulness. Material and method: Retrospective study of a series of cases. Pre and post-treatment auditoryperceptual evaluations were carried out and otorhinolaryngological reports were obtained in patients who featured vocal improvement. A sustained /a/ vowel was recorded. Perturbation measures and harmonics-to-noise ratio were analyzed, generating a narrow-band spectrogram. Results: Eight patients between the ages of 10 and 62 were included. Jitter improved in five patients, shimmer did in seven, and the harmonics-to-noise ratio improved in all of them. After treatment, the average improved in all the studied parameters. Pre- and post-treatment difference was not significant. In the narrow-band spectrogram, better harmonic structure and noise component reduction was observed in all cases. Conclusiones: Four out of said eight patients showed favorable evolution in all the studied acoustic parameters. The perturbation measures and harmonics-to-noise ratio average was better after treatment, although the difference found was not significant. Narrow-band spectrogram is a complement which would improve the interpretation of the acoustic measures within a multidimensional and multiparametrical voice assessment.

Introdução: a avaliação vocal é multiparamétrica. Na dimensão acústica, os índices de perturbação e a relação harmônico-ruído já foram questionados. A espectrografia acústica nos permite realizar representações visuais da voz. O propósito deste trabalho é analisar se os índices de perturbação e a relação harmônico-ruído melhoram em pacientes que apresentaram uma boa evolução vocal e descrever a utilidade do espectrograma de banda estreita. Material e método: Estudo retrospectivo de uma série de casos. Foram realizadas avaliações perceptuais, obtendo-se laudos otorrinolaringológicos pré e pós-tratamento em pacientes que apresentaram boa evolução vocal pós-tratamento. Com a gravação da vogal /a/ sustentada, foi feita a análise dos índices de perturbação e harmônico-ruído, gerando um espectrograma de banda estreita. Resultados: O estudo envolveu oito pacientes de entre 10 e 62 anos. O jitter indicou melhora em cinco pacientes, o shimmer em sete e o harmônico-ruído, na totalidade. A média melhorou em todos os parâmetros estudados após o tratamento. A diferença pré e pós-tratamento não resultou significativa. O espectrograma de banda estreita mostrou uma melhor definição da estrutura harmônica e diminuição do componente de ruído em todos os casos. Conclusões: Quatro dos oito pacientes apresentaram evolução favorável em todos os parâmetros. A média dos índices de perturbação e harmônico ruído foi melhor após o tratamento, embora a diferença encontrada não tenha sido significativa. O espectrograma de banda estreita é um complemento que permitiria melhorar a interpretação dos índices de perturbação e harmônico-ruído dentro de uma avaliação vocal multidimensional e multiparamétrica.

Relationship between Voice Fatigue and Voice Assessment in Patients with Voice Disorders and Applicability of Voice Fatigue Index in Korean Version / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Vocal fatigue is a symptom and a term that has been frequently used in the clinical study. Although a recently developed vocal fatigue index (VFI), a self-report questionnaire that reliably identifies vocal fatigue patients, provides detailed characteristics of the symptom, there has been no study about the association between VFI and other voice assessment parameters. This study aimed to investigate whether there is a relationship between VFI and the established voice assessment in Korean patients. SUBJECTS AND METHOD: Two hundred fifty-seven patients with voice disorders (mean age, 49.48±14.34; 145 male and 112 female) undertook the voice assessment that consisting of perceptual judgment [Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS) Scale], acoustic and aerodynamic analysis, and voice handicap index (VHI) questionnaire. All patients validated using VFI. Correlation analysis between each voice assessment and VFI was conducted. RESULTS: There were statistical significances between items of voice assessment and VFI. Among the GRBAS Scale, G, B, A, S and a number of acoustic measures were associated with vocal fatigue. In particular, these features were prominent in men. As the score of VFI increased, the sound pressure level during voicing and the phonation time from aerodynamic measures were decreased while the mean pitch was increased. In addition, VFI was closely correlated with pre-existing self-report questionnaire and VHI in both gender. CONCLUSION: These findings suggest that VFI has a significant association with pre-established voice assessment. Therefore, VFI can be used as a reliable tool for identifying and validating vocal fatigue in Korean.

The SLP's Perspectives for the Vocal Elites and Singing Voice

This article addresses the roles of the speech language pathologist (SLP) for singers who require prompt and effective treatment when a voice problem arises. The causes of voice problem are often vocal abuse/misuse/overuse, muscle tension dysphonia and inappropriate singing technique. The SLP should conduct voice counseling and voice assessment for maintaining healthy voice of singer constantly.

Clinic Value of the Vocal Acoustics on Voice Evaluation in Patients with Larynx Leukoplakia / 天津医药

Objective To explore the clinic value of the vocal acoustics on voice evaluation in larynx leukoplakia pa?tients. Methods Dr. Speech software was used to perform voice acoustic analysis and deduce EGG parameters in 48 sub?jects with larynx leukoplakia and 50 normal subjects. Voice acoustic analysis parameters (Jitter, Shimmer, NNE, HNR, SNR, MPT), EGG parameters ( EGG-Jitter、EGG-Shimmer、EGG-NNE、EGG-HNR、EGG-SNR, CQP,CIP) and EGG wave?form were compared between two groups. Results For voice acoustic analysis, Jitter, Shimmer, NNE in larynx leukoplakia group were higher than those in normal group while HNR, SNR in larynx leukoplakia group were lower than those of normal group. What’s more,MPT in larynx leukoplakia group was obviously shorter than that in normal group with, statistically sig?nificant difference (P<0.05). For EGG analysis, EGG-Jitter, EGG-Shimmer, EGG-NNE were higher in larynx leukoplakia group than those in normal group with significant difference (P<0.05). EGG-HNR and EGG-SNR in larynx leukoplakia group were lower than those in normal group. Furthermore, CQP and CIP in larynx leukoplakia group were higher than those normal group with statistically significant difference (P<0.05). Most patients’(72.9%) EGG waveform showed gradually ac?celerate phase velocity and fast close phase, which represent a spike-like shape. Conclusion Voice acoustic analysis com?bined with EGG provide objective indicators to assess degree of hoarseness, and to provide sonic evidences for prevention, recurrence, assessment and pronunciation correction of the larynx leukoplakia.

Classificação de sinais de vozes saudáveis e patológicas por meio da combinação entre medidas da análise dinâmica não linear e codificação preditiva linear / Healthy and pathological voice assessment by means of nonlinear dynamic analysis measures and linear predictive coding

Análise acústica tem sido sugerida como uma ferramenta auxiliar não invasiva e de baixo custo ao diagnóstico de patologias laríngeas. Diversas são as técnicas empregadas, entre as quais técnicas baseadas no modelo linear de produção da fala e na análise dinâmica não linear de sinais de vozes. O primeiro método é baseado na Teoria fonte-filtro, em que a fonte é a laringe e o filtro é o trato vocal. Nesse modelo, os sons surdos são modelados por uma fonte de ruído aleatório e os sons sonoros por um trem de impulsos na frequência fundamental do locutor. Na abordagem não linear são considerados aspectos da voz humana, não explorados no modelo linear, tais como: variação temporal da forma do trato vocal, as ressonâncias associadas à sua fisiologia, as perdas devido ao atrito nas paredes internas do trato vocal, a radiação do som nos lábios, o acoplamento nasal e o comportamento dinâmico associado à vibração das pregas vocais. Neste trabalho são associadas as duas abordagens e avaliado o desempenho na classificação com as características, de forma individual, e a partir da combinação das mesmas. São empregadas oito medidas oriundas da análise dinâmica não linear (dimensão de correlação, quatro medidas de entropia, expoente de Hurst, maior expoente de Lyapunov e o primeiro mínimo da função de informação mútua), além de coeficientes LPC, obtidos a partir da análise preditiva linear. Os resultados sugerem a viabilidade da técnica empregada para a discriminação entre vozes saudáveis e patológicas em geral, como também entre vozes afetadas por patologias laríngeas distintas como edema, nódulos e paralisia nas pregas vocais.

Acoustic analysis has been suggested as a noninvasive aiding and low cost tool for laryngeal disease diagnosis. Several techniques are employed using either the linear model of speech production, or the nonlinear dynamic analysis of voice signals. The first method is based on source-filter theory, in which the source is the larynx and the filter is the vocal tract. In this model, the unvoiced sounds are modeled by a random noise source and the voiced ones by impulse train at the speaker fundamental frequency. In nonlinear approach, aspects of the human voice are considered, not explored in the linear model, such as temporal variation of the vocal tract shape, resonances associated with its physiology, losses due to friction in the vocal tract inner walls, sound radiation in the lips, nose coupling and dynamic behavior associated with vocal fold vibration. This work combines the two approaches and evaluates the performance in classifying the features individually, and from their combination. Eight measures are employed derived from the nonlinear dynamic analysis (correlation dimension, four entropy measures, Hurst exponent, the largest Lyapunov exponent and the first minimum of mutual information function), besides LPC coefficients obtained from linear predictive analysis. The results suggest the feasibility of the employed technique to discriminate between healthy and pathological voices in general, but also among specific laryngeal diseases as vocal fold edema, nodules and paralysis.

Voice Characteristics of Adductor Spasmodic Dysphonia before and after Botulinum Toxin-A Injection / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Botulinum toxin type A (BTX-A) injection is well known for its effectiveness in the treatment of "Spasmodic dysphonia". However, studies on the efficacy of BTX-A injection have not been attempted in Korea. Therefore, this study was carried out to investigate the effects of BTX-A. SUBJECTS AND METHOD: The study examined 12 female patients with 'adductor spasmodic dysphonia'. Objective assesments included aerodynamic analysis and electoroglottography (EGG) of each patient before and after BTX-A. Subjective assessments included using the Korean-version of Voice Handicap Index-30 (KVHI-30) and a patient self-rating scale. RESULTS: Aerodynamic analysis revealed that only maximum phonation time (MPT) was significantly shortened after the injection of BTX-A (p<0.05). In the EGG, the mean frequency distribution was significantly increased, while the mean amplitude and the mean closed quotient distribution were significantly decreased (p<0.05). The KVHI-30 and patient self-rating scale scores were significantly decreased (p<0.01) as well, demonstrating the effects of BTX-A on the quality of life. CONCLUSION: Our results show the effects of BTX-A objectively by comparing voice characteristics, which were measured through EGG before and after BTX-A injection, as well as by determining aerodynamic characteristics. The subjective self-assessment on the quality of life is significant as it may serve as a clinically relevant measure. This study may be helpful in elucidating treatment efficacy of BTX-A in many ways.