A Study of Voice Handicap and Acoustic Measures in Arab Kuwaiti Prospective Professional Singers.

INTRODUCTION: Despite its clinical significance, few studies have explored the applicability of the validated Arabic version of the Voice Handicap Index (VHI-Arab) in professional voice users, especially singers. The correlation between VHI-Arab scores and acoustic measures in this targeted group remains unclear. The aim of this study was to explore Arab Kuwaiti prospective professional singers' perception of voice handicap using the validated VHI-Arab. Additionally, we examined the association between VHI-Arab scores and acoustic measures such as fundamental frequency (F0), shimmer, jitter, and signal-to-noise ratio. METHODS: VHI-Arab scores and acoustic measures of 100 adult prospective professional singers (50 females and 50 males) were compared with those of 100 adult controls (50 females and 50 males). RESULTS: Female prospective professional singers differed significantly from female controls in terms of functional and physical subscale scores, total VHI-Arab scores, and shimmer and jitter values. Male prospective professional singers showed significant differences neither in VHI-Arab scores nor in acoustic measures; however, their shimmer values showed significant a difference. There was no correlation between VHI-Arab scores and acoustic measures. CONCLUSION: Kuwaiti prospective professional singers did not perceive their voice as handicapped. Female prospective professional singers had a better perception of their voice compared with female controls. The results of the current study suggest that the perception of voice handicap and acoustic measures are different attributes that do not correlate.

Validation of the Arabic version of vocal tract discomfort scale.

Aim: To explore the internal consistency, criterion validity, and discriminative validity of the Arabic version of the vocal tract discomfort scale (VTDS-Arab); and to establish cut-off scores for the VTDS-Arab.Methodology: An overall of 202 participants (31 patients with voice disorders of organic and functional causes, and 171 healthy subjects, mean age 25.3 ± 6.7) were recruited in this study. Participants completed the VTDS-Arab scale and the Arabic version of the voice handicap index (VHI-Arab).Results: The VTDS-Arab had a positive internal consistency confirmed by Cronbach's α = 0.91. The criterion validity of the VTDS-Arab was confirmed by the strong positive correlation between the total scores of the VTDS-Arab and the VHI-Arab (r = 0.64, p < .001). Patients scored higher than the healthy subjects in all the subscales of the VTDS-Arab (p < .001) which confirmed the discriminative validity of the VTDS-Arab. Age and gender were not found to affect the scores of the VTDS as confirmed by Pearson r test (r = 0.02, p = .80) and insignificant p values of Levene's test (F1, 200 = 0.43, p = .51), respectively, which supports the validity of the VTDS-Arab. The study posited interpretations for the ranges of scores of the VTDS-Arab based, where the cut-off score for the VTDS-Arab total was 26.Conclusion: The VTDS-Arab is a reliable and a clinically valid tool that can be used in the evaluation of voice disorders alongside other subjective and objective tools of evaluation.

Applicability of the Arabic version of Vocal Tract Discomfort Scale (VTDS) with student singers as professional voice users.

AIM: This pilot study aimed to evaluate the internal consistency, convergent construct validity and criterion validity of Arabic version of the Vocal Tract Discomfort Scale (VTDS), and to investigate the correlation between the scores of the VTDS, the VHI and the acoustic measures of fundamental frequency (F0), shimmer, jitter and signal-to-noise ratio (SNR). METHODOLOGY: A cross-sectional study where 97 participants participated (47 males and 50 females) (mean age 20.5 ± 2.1 years) (31 student singers and 66 other non-professional voice user students). Participants were without self-perceived voice disorders who completed the VTDS-Arab scale and the Voice Handicap Index (VHI-Arab), and recorded a vocal sample of/a:/at a comfortable level. RESULTS: A positive internal consistency that signifies reliability was confirmed by Cronbach's α = .884 and 0.874 for the VTDS-Arab frequency and severity subscales, respectively. A moderate positive correlation was found between the VTDS-Arab (frequency, severity, total) and the VHI-Arab total where values of Pearson's correlation coefficient were r= 0.459, 0.430 and 0.451, respectively. Weak correlations were found between all of the acoustic measures and the scores of the VTDS-Arab and VHI-Arab (total and subscales). The area under curve for the VTDS was AUC= 0.824, 0.804 and 0.817 for the VTDS frequency, VTDS severity and VTDS total, respectively. CONCLUSIONS: The VTDS-Arab is a valid and reliable tool in measuring vocal tract sensations and predicting the perception of vocal handicap in student singers and can be used to predict the vocal load among professional voice users.

A study of VHI scores and acoustic features in street vendors as occupational voice users.

PURPOSE: to investigate acoustic features of phonation and perception of voice handicap in street vendors. METHODS: Eighty-eight participants (44 street vendors, 44 controls) were recruited. The mean age of the group was 38.9±16.0 years (range: 20-78 years). Scores of the Arabic version of the Voice Handicap Index (VHI-Arab) were used for analysis. Acoustic measures of fundamental frequency (F0), jitter, shimmer, and signal-to-noise ratio (SNR) were also analyzed. RESULTS: Analysis showed a significant difference between street vendors and controls in the total score of the VHI-Arab (p<0.001) as well as scores of all three VHI-Arab subsections: functional (p<0.001), physical (p<0.001), and emotional (p=0.025). Weak correlations were found among all of the VHI scores and acoustic measures (-0.219≤ r≤0.355), except for SNR where a moderate negative correlations were found (r=-0.555; -0.4) between the VHI (physical and total) scores and SNR values. Significant differences also were found in F0, jitter, and SNR among specific subgroups of street vendors when stratified by weekly hours worked (p<0.05), and in jitter (p=0.39) when stratified by educational level. CONCLUSIONS: Perception of voice handicap and a possible effect on vocal quality in street vendors were noted. The effect of factors, namely work hours and educational level, on voice quality should be further studied.

Kuwaiti Teachers' Perceptions of Voice Handicap.

OBJECTIVES: The study aimed to investigate the effects of age, gender, level of education, experience, and class level taught on the perception of voice handicap by Kuwaiti teachers using the Arabic version of the Voice Handicap Index (VHI-Arab). The mean VHI scores of Kuwaiti teachers were compared with those of Jordanian and Emirati teachers. METHODS: The study had a cross-sectional survey design. A total of 460 individuals (100 controls and 360 teachers) participated in this study and completed the paper copy of the VHI-Arab. We recruited 360 teachers, 180 males and 180 females (age range: 20-50 years), from 60 schools in 6 Kuwaiti districts. Teachers' VHI scores were compared with 100 nonteaching voice users (50 males and 50 females, with an age range of 18-42 years). RESULTS: Female teachers scored significantly higher than male teachers in all subscales (ie, physical: P = 0.02; emotional: P = 0.007; total: P = 0.017), except for the functional subscale (P = 0.147). Elementary school teachers scored significantly higher than teachers of other levels (middle and high school) in all VHI subscales (physical: P = 0.047; emotional: P = 0.01; total: P = 0.039), except for the functional subscale (P = 0.47). The mean score of Jordanian teachers was higher than that of Kuwaiti and Emirati teachers in all VHI subscales. CONCLUSIONS: Teachers with a more favorable teaching environment scored better on the VHI. Gender differences were found in all the Arabic nationalities studied. Female teachers of the elementary level, in particular, should be the focus of attention of efforts to prevent voice damage.

Emirati Teachers' Perceptions of Voice Handicap.

OBJECTIVES: The purpose of the study was to explore Emirati teachers' perceptions of voice handicap and to analyze their acoustic characteristics to determine whether acoustic measures of teachers' voice would verify their perceptions of voice handicap. METHODS: Sixty-six Emirati school teachers (33 men and 33 women), with different years of teaching experience and age, and 100 control participants (50 men and 50 women) underwent vocal assessment that included the Voice Handicap Index (VHI-Arab) and acoustic measures (F0, jitter%, shimmer%, signal to noise ratio [SNR]). RESULTS: Significant differences between the teachers' group scores and the control group scores on the following subscales of VHI-Arab: physical (P = 0.006), emotional (P = 0.004), and total score of the test (P = 0.002). No significant differences were found among teachers in the three VHI subscales, and the total score regarding gender (functional P = 0.307; physical P = 0.341; emotional P = 0.126; and total P = 0.184), age (functional P = 0.972; physical P = 0.525; emotional P = 0.772; and total P = 0.848), and years of teaching experience (functional P = 0.319; physical P = 0.619; emotional P = 0.926; and total P = 0.638). The significant differences between the teacher's group and the control group in three acoustic measures: F0 (P = 0.000), shimmer% (P = 0.000), and SNR (P = 0.000) were further investigated. Significant differences were found among female and male teachers in F0 (P = 0.00) and SNR (P = 0.007). As for teachers' age, significant differences were found in SNR (P = 0.028). Teachers' years of experience did not show significant differences in any of the acoustic measures. CONCLUSIONS: Teachers have a higher perception of voice handicap. However, they were able to produce better voice quality than control participants were, as expressed in better SNRs. This might have been caused either by manipulation of vocal properties or abusive overloading the vocal system to produce a procedurally acceptable voice quality.

Jordanian teachers' perceptions of voice handicap.

This study aimed to investigate if Jordanian school teachers perceive their voice as handicapped using the Voice Handicap Index (VHI)-Arab. The effect of teachers' age, gender, years of teaching, class taught, and education level on VHI was examined. A total of 289 teachers and a control group of 100 participants took part in the study. The teachers' group differed significantly from the control group in the physical, emotional, and functional subscales and the total score of the VHI-Arab. There was no significant difference among teachers in any of the three VHI subscales or total regarding gender, age, years of teaching experience, education level, and classes taught. Jordanian teachers have a strong perception of voice handicap. Thus, preventive and treatment vocal programs are strongly advised.

The respiratory muscle capabilities of Jordanian patients with multiple sclerosis.

The aim of this study was to evaluate the maximum expiratory pressure (MEP) and maximum inspiratory pressure (MIP) of Jordanian patients (19 females and 20 males) with multiple sclerosis (MS). A control group of 28 females and 26 males was included for the purposes of comparison. For the MS group, MIP results were as follows: female = 53.5 ± 36, male = 88.6 ± 40.9. MEP results were: female = 37.7 ± 13, male = 8.94 ± 30.3. The control group results were as follows: MIP female = 56.2 ± 43.8, male = 109.2 ± 49.8; MEP results were female = 70.9 ± 16.7, male = 115 ± 44.8). The control group results were as follows: MIP female = 56.2 ± 43.8, male = 109.2 ± 49.8; MEP results were female = 70.9 ± 16.7, male = 115 ± 44.8). In the patient group, there were significant differences between the two genders' MIP and MEP values (P=0.00). Significant differences were also found between the MS group and control group in MEP values (P=0.00) but not in MIP values (P=0.208). Possible psychosocial consequences of MS on Jordanian patients were measured using the Voice Handicap Index (VHI)-Arab with the following results for female patients: functional=7.3±6.9, physical=6.7±7.1, emotional=5±6.8, and total=19±19.7 and for male patients: functional=8.4±8.5, physical=9.8±9.3, emotional=9.6±11.4, and total=27.7±19.7. The VHI-Arab scores for female controls were as follows: functional = 5.1 ± 3.6, physical = 4.4 ± 2.9, emotional = 1.9 ± 2, and total = 11.4 ± 6.3). Male controls VHI-Arab scores were as follows: functional = 3.8 ± 3.4, physical = 5 ± 3.6, emotional = 1.2 ± 1.4, and total = 10.1 ± 6.2. Significant differences were found between the MS group and control group in the VHI-Arab functional domain (VHIF) (P=0.006), physical domain (VHIP) (P=0.006), emotional domain (VHIE) (P=0.00), and total score (VHIT) (P=0.00) values. In conclusion, MS can limit effective communication and may cause higher perception of voice handicap.

Formant frequency characteristics in normal Arabic-speaking Jordanians.

This study is designed to test the acoustic characteristics of the normal Arabic voice. The subjects were 300 normal Arabic speakers (100 adult males, 100 adult females, and 100 children). The subjects produced a sustained phonation of the six steady state Arabic vowels (/i:/, /e:/, /a:/, , /o:/, and /u:/). The samples were input into the Time-Frequency Analysis Software (TF32). F0, F1, F2, and F3 of the six Arabic vowels were analyzed. Comparisons among speakers of Jordanian Arabic showed that males' formant frequencies were significantly different in comparison with those of females and children. On the other hand, a significant difference was found between females and children in F1, but not in F2 or F3. Comparison with other ethnicities indicated that adult Arab males' formant frequencies showed a generally lower F1 and F2 and a higher F3; adult Arab females' formant frequencies showed a generally higher F1 and lower F2 and F3; whereas children formant frequencies showed a generally lower F1, F2, and F3. It is recommended that speech-language pathologists in Jordan use the new formant norms when evaluating and/or treating Jordanian Arabic speakers.

Standardization of the Arabic version of the Voice Handicap Index: an investigation of validity and reliability.

Validity and reliability of the Arabic version of the VHI (VHI-Arab) were investigated. Possible effects of participant-inherent factors (i.e. age, sex) on participant (77 females, 35 males) responses were also investigated. Results showed high internal consistency (Cronbach's alpha r > 0.857 for all scores). Test-retest reliability was found to be strong (r > 0.87 for all scores). Validity results indicated significant moderate correlations between total VHI score and responses to severity (r = 0.521, P = 0.015) and satisfaction (r = 20.556, P = 0.009) questions. VHI-Arab was found to be unaffected by age (P > 0.10 for all scores) or sex (P > 0.05). This study produced a valid and reliable instrument for measuring participation restriction in Arabic-speaking individuals with voice disorders.

Fundamental frequency characteristics of Jordanian Arabic speakers.

This study is the first in a series of investigations designed to test the acoustic characteristics of the normal Arabic voice. The subjects were three hundred normal Jordanian Arabic speakers (100 adult males, 100 adult females, and 100 children). The subjects produced a sustained phonation of the vowel /a:/ and stated their complete names (i.e. first, second, third and surname) using a carrier phrase. The samples were analyzed using the Multi Dimensional Voice Program (MDVP). Fundamental frequency (F0) from the /a:/ and speaking fundamental frequency (SF0) from the sentence were analyzed. Results revealed a significant difference of both F0 and SF0 values among adult Jordanian Arabic-speaking males (F0=131.34Hz +/- 18.65, SF0=137.45 +/- 18.93), females (F0=231.13Hz +/- 20.86, SF0=230.84 +/- 16.50) and children (F0=270.93Hz +/- 20.01, SF0=278.04 +/- 32.07). Comparison with other ethnicities indicated that F0 values of adult Jordanian Arabic-speaking males and females are generally consistent with adult Caucasian and African-American values. However, for Jordanian Arabic-speaking children, a higher trend in F0 values was present than their Western counterparts. SF0 values for adult Jordanian Arabic-speaking males are generally consistent with the adult Caucasian male SF0 values. However, SF0 values of adult Jordanian-speaking females and children were relatively higher than the reported Western values. It is recommended that speech-language pathologists in Arabic-speaking countries, Jordan in specific, utilize the new data provided (F0 and SF0) when evaluating and/or treating Arabic-speaking patients. Due to its cross-linguistic variability, SF0 emerged as a preferred measurement when conducting cross-cultural comparisons of voice features.

The performance of the time-frequency analysis software (TF32) in the acoustic analysis of the synthesized pathological voice.

The purpose of this study was to examine the algorithm-measuring capabilities used in the Time-Frequency Analysis Software Program for 32-bit Windows (TF32) for measuring fundamental frequency (F0), its dependent measures, and signal-to-noise ratio (SNR). The stability, accuracy, and linearity of its algorithm to systematic changes in aspiration noise and/or spectral slope (to mimic the perceptual characteristics of breathiness, roughness, and hoarseness) were evaluated using its analysis output to five female and five male synthesized voices. TF32 was used to calculate F0, Jitter%, Shimmer%, and SNR for each of the synthesized signals. The findings indicate that although TF32 produced stable results for male synthesized samples, they were not accurate when measuring F0, Jitter%, and Shimmer% with the addition of noise and variations in open quotient independently and in combination. In contrast, TF32 was neither stable nor accurate in making the same measurements for female synthesized samples. However, TF32 was stable and accurate in measuring SNR for male and most of female voices. These results point to an inappropriate F0 extraction algorithm in TF32 and stress the need for further research to remediate the algorithm or to identify a superior one.