Reliability and Correlations Between Overall Severity, Roughness and Breathiness in the Perception of Dysphonic Voices: Investigating Cognitive Aspects.

OBJECTIVES: this study concerns the subjective perception of the quality of the voice, more particularly in the case of dysphonia. Our general objective is to study the perceptual mechanisms, which constitute Hirano's GRBAS multidimensional perceptual rating scale. MATERIAL AND METHODS: We tested the reliability of the GRB perceptual scale both in terms of test-retest reliability (intra-listener stability) and in terms of inter-listener agreement. We also studied how listeners process the three different parameters of the scale by varying the perceptual rating conditions of G, R, and B. The three attributes were rated simultaneously in one condition and in isolation in a second condition. The experiment was based on texts read by fifty dysphonic speakers. We selected five listeners specialized in voice assessment to provide perceptual judgments of the voices. RESULTS AND CONCLUSIONS: Our results show that G is strongly correlated with R and/or B. When the GRB rating process is simultaneous, G is almost equal to the maximum score assigned to the R and/or B parameter (R² = 0.97). Conversely, R and B are poorly correlated. While intra-listener variability was limited, inter-judge variability was important even in a homogeneous panel of judges.

Transmission of droplet-conveyed infectious agents such as SARS-CoV-2 by speech and vocal exercises during speech therapy: preliminary experiment concerning airflow velocity.

PURPOSE: Infectious agents, such as SARS-CoV-2, can be carried by droplets expelled during breathing. The spatial dissemination of droplets varies according to their initial velocity. After a short literature review, our goal was to determine the velocity of the exhaled air during vocal exercises. METHODS: A propylene glycol cloud produced by 2 e-cigarettes' users allowed visualization of the exhaled air emitted during vocal exercises. Airflow velocities were measured during the first 200 ms of a long exhalation, a sustained vowel /a/ and varied vocal exercises. For the long exhalation and the sustained vowel /a/, the decrease of airflow velocity was measured until 3 s. Results were compared with a Computational Fluid Dynamics (CFD) study using boundary conditions consistent with our experimental study. RESULTS: Regarding the production of vowels, higher velocities were found in loud and whispered voices than in normal voice. Voiced consonants like /ʒ/ or /v/ generated higher velocities than vowels. Some voiceless consonants, e.g., /t/ generated high velocities, but long exhalation had the highest velocities. Semi-occluded vocal tract exercises generated faster airflow velocities than loud speech, with a decreased velocity during voicing. The initial velocity quickly decreased as was shown during a long exhalation or a sustained vowel /a/. Velocities were consistent with the CFD data. CONCLUSION: Initial velocity of the exhaled air is a key factor influencing droplets trajectory. Our study revealed that vocal exercises produce a slower airflow than long exhalation. Speech therapy should, therefore, not be associated with an increased risk of contamination when implementing standard recommendations.

Feasibility of First Injection of Autologous Adipose Tissue-Derived Stromal Vascular Fraction in Human Scarred Vocal Folds: A Nonrandomized Controlled Trial.

Importance: Patients with scarred vocal folds, whether congenitally or after phonosurgery, often exhibit dysphonia that negatively affects daily life and is difficult to treat. The autologous adipose tissue-derived stromal vascular fraction (ADSVF) is a readily accessible source of cells with angiogenic, anti-inflammatory, immunomodulatory, and regenerative properties. Objective: To evaluate the feasibility and tolerability of local injections of autologous ADSVF in patients with scarred vocal folds. Design, Setting, and Participants: CELLCORDES (Innovative Treatment for Scarred Vocal Cords by Local Injection of Autologous Stromal Vascular Fraction) is a prospective, open-label, single-arm, single-center, nonrandomized controlled trial with a 12-month follow-up and patient enrollment from April 1, 2016, to June 30, 2017. Eight patients with severe dysphonia attributable to vocal fold scarring associated with a congenital malformation or resulting from microsurgical sequelae (voice handicap index score >60 of 120) completed the study. Data analysis was performed from September 1, 2018, to January 1, 2019. Interventions: Injection of ADSVF into 1 or 2 vocal folds. Main Outcomes and Measures: The primary outcomes were feasibility and the number and severity of adverse events associated with ADSVF-based therapy. The secondary outcomes were changes in vocal assessment, videolaryngostroboscopy, self-evaluation of dysphonia, and quality of life at 1, 6, and 12 months after cell therapy. Results: Seven women and 1 man (mean [SD] age, 44.6 [10.4] years) were enrolled in this study. Adverse events associated with liposuction and ADSVF injection occurred; most of them resolved spontaneously. One patient received minor treatment to drain local bruising, and another experienced a minor contour defect at the liposuction site. At 12 months, the voice handicap index score was improved in all patients, with a mean (SD) improvement from baseline of 40.1 (21.5) points. Seven patients (88%) were considered to be responders, defined as improvement by 18 points or more in the voice handicap index score (the minimum clinically important difference). Conclusions and Relevance: The findings suggest that autologous ADSVF injection in scarred vocal folds is feasible and tolerable. The findings require confirmation in a randomized clinical trial with a larger population. Trial Registration: ClinicalTrials.gov Identifier: NCT02622464.

Translation, Adaptation, and Preliminary Validation of Dacakis and Davies' "Transsexual Voice Questionnaire (Male to Female)" in French.

Transgender MtF people (trans women) consult otorhinolaryngologists and vocologists with the aim of feminizing their voice and being consistently perceived as women. Treatment of these trans women always begins with a vocal assessment that is relatively unspecific as it was originally constructed for individuals with dysphonia. OBJECTIVES: This study examines the subjective portion of the assessment and specifically the self-assessment questionnaire. There is no French-language questionnaire designed to identify the issues facing people who want voice feminization and quantify the impact of their voice disorder on their daily lives. We present a translation and adaption into French of the questionnaire developed by Dacakis et al [6]. METHODS: This work follows the World Health Organization recommendations [12] regarding translation. Thirty-six Belgian and French trans women took part in this study. RESULTS: The results show excellent repeatability and reliability, while the construct validity measures show that the items correlate with six areas of concern for trans women identified by Davies and Johnson [7] in a previous study. The domains are the following: effect of voice on ease of social interaction, effect of voice on emotions, relationship between voice and gender identity, effort and concentration required to produce voice, physical aspects of voice production, and pitch. Concurrent validity could not be measured owing to lack of sufficiently detailed stories. CONCLUSION: The psychometric properties of the French version of the questionnaire are acceptable. The questionnaire can be used as is in daily clinical practice.

Personality traits inventory in patients with vocal nodules.

The objective of the study was to analyze temperament and character in females with vocal nodules (VN) compared to a vocally healthy control population. 61 females were examined over a 17-month period for dysphonia with VN (mean age 46 years, duration of vocal complaints from 2 months to 6 years). 71 control females were recruited in their environment (mean age 34 years). The validated French Version of the Temperament and Character Inventory (TCI) was used. Patients with VN had significantly (p < 0,05) greater scores for Persistence and Novelty Seeking, particularly for the subscales exploratory excitability and extravagance. They had lower scores for Harm Avoidance, in particular fear of uncertainty, shyness and fatigability. Scores on Reward Dependence were not significantly different except for the subscale dependence, which were significantly lower in patients. No significant difference was found with regard to scores on Self-directedness, except for scores on the subscale self-acceptance, which were significantly lower in patients. Scores on Cooperativeness were not significantly different, except for the subscale helpfulness, which were significantly higher in patients. Patients had significant greater scores for Self-transcendence overall and specifically on the subscales self-forgetfulness and spiritual acceptance. Our findings suggested that women with VN are likely to have a passionate temperament, which might constitute an indirect predisposition to elevated vocal loading and greater risk for phonotrauma. The risk for developing or maintaining VN could be decreased by attending to those personality-specific maladaptive behaviors. A possible personalized approach to voice therapy could be organized on the basis of the TCI findings.

Perceptual evaluation of dysphonic voices: can a training protocol lead to the development of perceptual categories?

The purpose of this study was to develop and test a training protocol for the perceptual evaluation of dysphonia. A group of 38 inexperienced listeners participated in a three-phase experiment: a pretest to evaluate their initial performance on categorization of dysphonic voices, a training phase, and a posttest to detect training-related changes in performance. In parallel, a different group of 14 listeners who were experts in voice assessment took a test that was identical to the posttest taken by the inexperienced subjects. The corpus used for the tests was made up of recordings of 142 voices of women reading aloud, with a sampling of voice qualities ranging from normal to severely degraded. The learners' performance on judgments of moderate and severe dysphonia improved between the pretest and the posttest. No improvement was observed for normal voices, whose initial detection was already good, nor for slight dysphonias, which appear to be the most difficult to learn. The improvements were still present on a delayed posttest taken a week later. Unexpectedly, the inexperienced listeners' initial performance was similar to that of the experts. After the training phase, their scores for severely deteriorated voices were even better than the experts'. In conclusion, our training protocol seems to be effective and could therefore be proposed to voice therapists. However, judging intermediate degrees of dysphonia remains fragile and therefore needs to be reinforced by repeated training.

Top-down mechanisms in dysphonia perception: the need for blind tests.

The purpose of this study was to determine the extent to which the information a therapist or a physician has about a dysphonic speaker, particularly whether he or she is in the pretreatment or posttreatment period, can influence judgments of the patient's voice. The voices of 53 dysphonic speakers were used in the study. For each speaker, we selected a pair of voice samples recorded under different circumstances. Seven listeners who were speech therapists, ear, nose, and throat surgeons, or voice pathologists took blind-listening tests in which they were asked to compare the two voices in each pair (phase 1: blind listening). A few weeks later, the listeners took the very same test again, except that this time, they were given bogus information about whether the speaker had/had not been treated by laryngeal surgery or speech therapy (phase 2: influenced listening). The information given for each voice sample either reinforced the judgment made in phase 1 (eg, the voice judged to be better on the blind test was said to be posttreatment) or countered that judgment (eg, the voice rated as better on the blind test was said to be pretreatment). The influenced-listening results showed that in the reinforced condition, the original ratings were significantly amplified. By contrast, in the countering-influence condition, decision changes were frequent: we found that judgment reversals and the countering-information scores were almost independent of the blind-listening scores. These findings point out the dire need to use a blind protocol in perceptual assessments of dysphonia.

Vocal flexibility and prosodic strategies in a professional impersonator.

OBJECTIVES/HYPOTHESIS: Voice imitation of a famous personality results in detection and reproduction of some vocal features, including spectral characteristics but also prosody, speech flow, or articulatory patterns. The objective of this study was to describe vocal flexibility in one of the best French impersonators and determine his strategies. STUDY DESIGN: Prospective study. METHOD: We have downloaded the recording of a political speech by former French President Jacques Chirac, who we have chosen for his very specific and recognizable voice. After transcription, we asked one professional impersonator and four control subjects to do several readings in their natural voice and in a spontaneous imitation task (ie, without listening to any of Chirac's recording). To facilitate the control subject's task, we made an additional recording after having them listen to the target sample. Using Praat freeware, we have compared several prosodic measurements taken on each sample: pitch, pitch range, articulatory speed, duration of pauses, and number of pauses. RESULTS: Results showed significant modifications in the participant's prosody and significant differences in the strategies used by the professional impersonator and the control group. CONCLUSION: The professional impersonator's imitation strategy lies in the reproduction of global characteristics and instant alignment of prosodic variations.

Correlation of instrumental voice evaluation with perceptual voice analysis using a modified visual analog scale.

Various rating scales have been used for perceptual voice analysis including ordinal (ORD) scales and visual analog (VA) scales. The purpose of this study was to determine the most suitable scale for studies using perceptual voice analysis as a gold standard for validation of objective analysis protocols. The study was carried out on 74 female voice samples from 68 dysphonic patients and 6 controls. A panel of 4 raters with experience in perceptual analysis was asked to score voices according to the G component (overall quality) of the GRBAS system. Two rating scales were used. The first was a conventional 4-point ORD scale. The second was a modified VA (mVA) scale obtained by transforming the VA scale into an ORD scale using a weighted conversion scheme. Objective voice evaluation was performed using the EVA workstation. Objective measurements included acoustic, aerodynamic, and physiologic parameters as well as parameters based on nonlinear mathematics (e.g., Lyapunov coefficient). Instrumental measurements were compared with results of perceptual analysis using either the conventional ORD scale or mVA scale. Results demonstrate that correlation between perceptual and objective voice judgments is better using a mVA scale than a conventional ORD scale (concordance, 88 vs. 64%). Data also indicate that the mVA scale described herein improves the correlation between objective and perceptual voice analysis.