Tridimensional assessment of adductor spasmodic dysphonia pre- and post-treatment with Botulinum toxin.

Spasmodic dysphonia voices form, in the same way as substitution voices, a particular category of dysphonia that seems not suited for a standardized basic multidimensional assessment protocol, like the one proposed by the European Laryngological Society. Thirty-three exhaustive analyses were performed on voices of 19 patients diagnosed with adductor spasmodic dysphonia (SD), before and after treatment with Botulinum toxin. The speech material consisted of 40 short sentences phonetically selected for constant voicing. Seven perceptual parameters (traditional and dedicated) were blindly rated by a panel of experienced clinicians. Nine acoustic measures (mainly based on voicing evidence and periodicity) were achieved by a special analysis program suited for strongly irregular signals and validated with synthesized deviant voices. Patients also filled in a VHI-questionnaire. Significant improvement is shown by all three approaches. The traditional GRB perceptual parameters appear to be adequate for these patients. Conversely, the special acoustic analysis program is successful in objectivating the improved regularity of vocal fold vibration: the basic jitter remains the most valuable parameter, when reliably quantified. The VHI is well suited for the voice-related quality of life. Nevertheless, when considering pre-therapy and post-therapy changes, the current study illustrates a complete lack of correlation between the perceptual, acoustic, and self-assessment dimensions. Assessment of SD-voices needs to be tridimensional.

Voicing quantification is more relevant than period perturbation in substitution voices: an advanced acoustical study.

Quality of substitution voicing-i.e., phonation with a voice that is not generated by the vibration of two vocal folds-cannot be adequately evaluated with routinely used software for acoustic voice analysis that is aimed at 'common' dysphonias and nearly periodic voice signals. The AMPEX analysis program (Van Immerseel and Martens) has been shown previously to be able to detect periodicity in irregular signals with background noise, and to be suited for running speech. The validity of this analysis program is first tested using realistic synthesized voice signals with known levels of cycle-to-cycle perturbations and additive noise. Second, exhaustive acoustic analysis is performed of the voices of 116 patients surgically treated for advanced laryngeal cancer and recorded in seven European academic centers. All of them read out a short phonetically balanced passage. Patients were divided into six groups according to the oscillating structures they used to phonate. Results show that features related to quantification of voicing enable a distinction between the different groups, while the features reporting F(0)-instability fail to do so. Acoustic evaluation of voice quality in substitution voices thus best relies upon voicing quantification.

Perceptual evaluation of substitution voices: development and evaluation of the (I)INFVo rating scale.

Substitution voicing cannot be evaluated accurately by the GRBAS perceptual rating scale, and there is a need for a valuable alternative. Therefore, we developed and tried out a perceptual rating scale, consisting of five new parameters: impression, intelligibility, noise, fluency and voicing, each to be scored between 0 (very bad score) to 10 (very good score for a substitution voice). In analogy to the GRBAS scale, they are then converted to deviance scores ranging from 0 (similar to good substitution voicing) to 3 (very deviant from good substitution voicing). Inter-individual agreement measured in a set of 24 semi-professional jury members seemed to be moderate for all parameters. Mean figures of 0.52, 0.51, 0.46, 0.53 and 0.46 are obtained for the parameters impression, intelligibility, noise, fluency and voicing, respectively. Because a high correlation exists between the first two parameters (0.917) and relying on the correlation figures between the two "I"s and the other parameters (correlation values for "impression" vary from 0.79-0.86; values for "intelligibility" range from 0.74-0.83), we suggest to discard the parameter impression, which turns the actual IINFVo scale into INFVo. The proposed (I)INFVo perceptual rating scale seems promising for the assessment of substitution voicing. Eventual improvements and practical proposals are discussed.