Diagnostic Accuracy of DSI and AVQI v.02.03 in Discriminating across the Perceptual Levels of Dysphonia in Kannada Speaking Population.

The present study investigated and compared the diagnostic accuracy of Dysphonia Severity Index (DSI) and Acoustic Voice Quality Index (AVQI) in Indian adults in the age range of 18-40years across different levels of dysphonia severity. Normophonic individuals (n=163) and individuals with dysphonia (n=134) were selected using purposive sampling in the age range of 18-40years. For DSI, Computerized Speech Lab 4500 and for AVQI, Praat 6.1.03 was used for recording. The results of receiver operating characteristics (ROC) analysis for DSI have revealed that DSI can discriminate the normophonic versus mild, mild versus moderate, and moderate versus severe dysphonic with cut-off values of 1.36, -1.83, and -4.07, respectively. The sensitivity and specificity reported for mild versus moderate and moderate versus severe are slightly lower for obtained threshold points. For AVQI v.02.03, ROC analysis revealed that high sensitivity and specificity cut-off points for normophonic versus mild, mild versus moderate, and moderate versus severe dysphonic are 2.50, 3.86, and 6.21, respectively. AVQI is a more effective technique than DSI for distinguishing between dysphonia severities levels, particularly when it comes to mild versus moderate and moderate versus severe, according to comparisons of AROC curves made using the DeLang method.

Voice quality in patients with temporomandibular disorders.

OBJECTIVES: This study assessed the voice quality in TMD patients compared to healthy individuals using the Dysphonia Severity Index (DSI) and evaluated the correlation between the DSI and TMD severity. METHODS: Patients who had TMD with Fonseca's anamnestic index were subjected to an examination based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). A sample of 35 patients with TMD and 36 healthy subjects were included in the study. RESULTS: There were significant differences in the DSI score and its components between healthy subjects and TMD patients (p < .001). A significant correlation was found between the DSI scores and TMD severity (Spearman's rho: -0.90, p < .001). CONCLUSION: Patients with TMD demonstrated lower DSI scores and lower voice quality compared to healthy subjects.

A Comparison of the Dysphonia Severity Index and Singing Voice Handicap Index Between Trained and Untrained Male Iranian Traditional Singers.

OBJECTIVES: This study aimed to compare trained and untrained Iranian traditional singers on the Dysphonia Severity Index (DSI) and the Singing Voice Handicap Index. The second objective was to examine the relationship between the DSI and Persian version of the Singing Voice Handicap Index (P-SVHI) scores in each group of trained and untrained Iranian traditional singers. STUDY DESIGN: This study is a comparative cross-sectional study. METHODS: This study included 17 trained male Iranian traditional singers who were compared with 17 untrained ones who were matched in terms of age. The P-SVHI was completed by trained and untrained Iranian traditional singers. Measures of jitter, lowest intensity, highest phonational frequency, and maximum phonation time (MPT) were obtained from each participant. The DSI scores were calculated using these values. RESULTS: Trained male traditional singers had an average age of 33.76 ± 7.45 years, 3.24 ± 1.85 hours of daily practice, 5.24 ± 3.78 years of training, 3.06 ± 2.65 no. of professional performances, and untrained singers had an average age of 32.76 ± 12.92 years, 1.53 ± 1.17 hours of daily practice, and 0.88 ± 1.65 no. of professional performances. Trained singers had lower P-SVHI scores and sub-scores, longer MPT, higher F0 high, lower jitter, and lower I low, resulting in higher DSI values (P < 0.05). There was no significant correlation between P-SVHI scores and DSI values in each group of trained and untrained Iranian traditional singers (P > 0.05). CONCLUSIONS: The results of this study show that the vocal abilities of professional vocalists are enhanced through voice training (higher DSI scores in trained singers vs untrained ones). Voice training can also help to lessen the perception of a handicap related to the singing voice. Hence, it may be necessary to consider alternative norms for the DSI and P-SVHI when administering them to patients who have undergone guided vocal training, such as voice/singing lessons. The current research indicates that the perception of singing voice handicap and DSI values are two distinct characteristics that do not have a significant correlation.

Comparing dysphonia severity index, objective, subjective, and perceptual analysis of voice in patients with multiple sclerosis and healthy controls.

BACKGROUND: Impairments in voice quality in Multiple Sclerosis (MS) have recently been investigated and different results were found. A voice-centered multidimensional assessment protocol with patient-reported outcome measures was conducted to evaluate all the aspects of the voice changes. OBJECTIVES: The study aimed to compare the objective, subjective, and perceptual measures of voice between the people with MS and the healthy control group. METHODS: A total of 128 participants, including 64 people with MS age, and gender-matched healthy controls were enrolled in the study. Subjective, objective, and auditory-perceptual voice assessments of the participants were performed. The auditory-perceptual evaluation was performed with GRBAS. The Dysphonia Severity index was computed for both groups. All the participants completed the Turkish version of The Voice Handicap Index-10 (VHI-10) and the Voice-Related Quality of Life (VRQoL). RESULTS: Acoustic and aerodynamic parameters of voice were found significantly different for both males and females between the MS and control group. DSI was found significantly different for both males and females in the MS group compared to the control group (p<0.05). All components of the GRBAS scale were significantly higher in the MS group (p<0.001). Using a multivariate regression model, it was determined that age, gender, EDSS score, number of MS attacks, and disease duration did not affect the DSI. The overall VHI-10 score was higher in the MS group (median=1.0 range= 0-28) and lower in the control group (median=0 range= 0-4). The mean VRQoL was lower in the MS group (median=95 range= 62.5-100) than in controls (median=100 range= 85-100) (p<0.001). CONCLUSION: Our results indicated that people with MS have significant differences in acoustic and aerodynamic parameters of voice compared to healthy individuals. A significant number of persons with MS are aware that their voice problem affects their quality of life. People with MS must be monitored for voice changes and a multidimensional voice assessment protocol should be implemented.

[Voice disorders associated with novel coronavirus infection]. / Narusheniya golosa u patsientov posle perenesennoi novoi koronavirusnoi infektsii.

OBJECTIVE: To evaluate the features of voice disorders associated with novel coronavirus infection and to develop the clinical algorithm for diagnostic and treatment these patients. MATERIAL AND METHODS: A prospective observational study was conducted in patients with dysphonia after COVID-19 (n=60). All patients underwent a comprehensive voice assessment before and after the proposed treatment. The follow-up period was 1 month. RESULTS: Functional dysphonia or aphonia with a stable (refractory) or recurrent course was diagnosed in 58 (97%) patients. A tendency to an increase in the value of the latent period of the P300 and MMN in patients with voice disorder was revealed. There was a significant decrease in supraglottic constriction and glottal insufficiency before and after the treatment. The mean VHI-10 decreased from 25.4 before treatment to 15.3 after treatment. The DSI which is based on the set of voice measurements, statistically significant improved from -5.2 to 2.6 in patients as a result of treatment. The average value of MFI-20 improved from 65.4 (8.7) at the beginning of the study to 20.3 (5.3) after treatment. CONCLUSION: In patients with dysphonia or aphonia associated with COVID-19 are indicated a refractory type of dysphonia. This was indicated by the study of AEPs of the brain. The clinical algorithm for treatment and diagnostic patients with voice disorders after COVID-19 has been developed. The treatment of this group of patients should be adjunct by the drug therapy, kinesiotaping method and psychotherapy.

The comparison between vocal facilitating techniques, manual circumlaryngeal therapy, and combined voice therapy in teachers with muscle tension dysphonia: a randomized clinical trial.

PURPOSE: Although voice therapy (VT) has been known effective in muscle tension dysphonia (MTD), it is not obviously clear which VT approach is more effective. This study aimed to compare the effectiveness of Vocal Facilitating Techniques (VFTs), Manual Circumlaryngeal Therapy (MCT), and combined VT in teachers with MTD. METHODS: This study was a double-blind parallel randomized clinical trial. Thirty elementary female teachers with MTD were divided into three treatment groups including VFTs; MCT, and combined VT. In addition, vocal hygiene was presented to all groups. All participants received 10 individual 45-min sessions of VT twice a week. The effectiveness was assessed using Vocal Tract Discomfort (VTD) scale and Dysphonia Severity Index (DSI) before and after treatment and improvement measurement was calculated. The participants and data analyzer were blinded to the type of VT. RESULTS: All groups showed significantly better results on the subscales of VTD scale and DSI score after VT (p ≤ 0.001; η2 ≥ 0.90). There was a significant difference between the three groups on the results of VTD scale and DSI score (p ≤ 0.05). The improvement measurement on the VTD severity subscale and DSI score following the combined VT was the greatest compared with other groups (η2 = 0.99 and 0.98, respectively). The significant interactive effect of treatment and time was observed on the VTD severity subscale and DSI score (p < 0.05; η2 ≥ 0.56). CONCLUSIONS: This study showed that the VFTs, MCT, and combined VT were effective for MTD teachers, and the combined VT is the most effective one. It seems the combination of different approaches is recommended for the VT of MTD patients.

The effects of transcutaneous electrical nerve stimulation on muscle activity pattern in professional voice users with muscle tension dysphonia using surface electromyography data: A pilot study.

OBJECTIVES: Muscle Tension Dysphonia is a voice disorder, which results in stiffness in the laryngeal extrinsic muscles, intense collision, painful contractions, and vibrations of the vocal cords. Due to the multifactorial identity of Muscle Tension Dysphonia, its therapeutic approach must be multidisciplinary. METHODS: The participants were divided into two groups: a control group (5participants) that received Circumlaryngeal Manual Therapy (CMT) + Placebo Transcutaneous Electrical Nerve Stimulation and an experimental group (5participants) that received Transcutaneous Electrical Nerve Stimulation + CMT. Both groups received 10 sessions of treatment, twice a week, for 40 min each. Before and after treatment, participants were assessed using the Dysphonia Severity Index (DSI) and surface electromyography for their ability to sustain the vowels /e& u/and count from 20 to30. RESULT: After therapy, there were substantial improvements in the DSI (2.72 ± 0.55, P < 0.05) and muscle electrical activity in the control group. The DSI (3.66 ± 0.63, P < 0.05) and muscle electrical activity were also significantly improved in the experimental group after treatment. The findings of the between-group comparison after treatment revealed a significantly greater increase in the Dysphonia Severity Index in the experimental group compared with the control group (P = 0.037). Although there was no significant difference between the two groups in terms of muscle electrical activity, clinically significant changes were more noticeable in the experimental group when compared with the control group. CONCLUSIONS: Positive results were seen in both groups. The results demonstrate that both approaches relax vocal tract muscles. As a result, Transcutaneous Electrical Nerve Stimulation was recommended as a complementary treatment for clients with Muscle Tension Dysphonia.

Nutritional Biomarkers as Predictors of Dysphonia Severity in Patients with Ischemic Stroke.

Dysphonia and malnutrition are major problems in patients who have suffered an ischemic stroke. Tools to assess dysphonia severity include the dysphonia severity index (DSI) and maximum phonation time (MPT). This study aimed to investigate whether the nutritional biomarkers transferrin, albumin, and prealbumin could be predictors of dysphonia severity. A retrospective analysis was conducted between January 2018 and October 2022. A total of 180 patients who had suffered an ischemic stroke were included. Serum transferrin, albumin, and prealbumin levels were significantly correlated with DSI and MPT levels. In a multiple regression analysis, prealbumin and transferrin were significant predictors of DSI, whereas only prealbumin was a significant predictor of MPT. Serum transferrin, albumin, and prealbumin levels in patients who have suffered an ischemic stroke may correlate with dysphonia severity as assessed using DSI and MPT. These results may provide objective evidence that nutritional biomarkers affect dysphonia severity.

Accuracy Analysis of the Multiparametric Acoustic Indices AVQI, ABI, and DSI for Speech-Language Pathologist Decision-Making.

PURPOSE: To investigate the accuracy of the Acoustic Voice Quality Index (AVQI), the Acoustic Breathiness Index (ABI), and the Dysphonia Severity Index (DSI) for speech-language pathologist (SLP) decision-making in the evaluation of teachers' voice conditions. METHODS: Cross-sectional observational study with a convenience sample composed of 21 teachers "fit" in carrying out their work activities as a teacher, and 21 considered "unfit" for the same. All teachers underwent a voice evaluation, carried out by a voice-specialized speech-language pathologist. Voice evaluation included the SLP's opinion on whether the teachers presented "fit" or "unfit" for work. The voice and speech samples used for the AVQI and ABI scores were the mid-three seconds of a sustained vowel /a/, and a spontaneous count from 1 to 10. The following parameters were used to extract the DSI score: mid-three seconds of a sustained vowel /a/, maximum phonation time of a sustained vowel /a/, ascending vocal glide on the vowel /a/ until reaching the highest pitch, and sustained vowel /a/ at the softest possible vocal intensity. The t-test was used to compare the difference between the AVQI and ABI indices. The Mann-Whitney test was used for the DSI index, with a confidence level of 95%. The receiver operating characteristic curve (ROC) was used for accuracy analysis. RESULTS: There was a difference in AVQI values (P=0.008), ABI (P=0.014), and DSI (P=0.000) between groups. The cutoff points that revealed the highest specificity for the AVQI, ABI, and DSI respectively were 3.33 (sensitivity 57.1% and specificity 90.5%), 4 (sensitivity 57.1% and specificity 85.7%), and 1.62 (sensitivity 71.4% and specificity 90.5%). CONCLUSION: The AVQI, ABI, and DSI are instruments that provide robust voice information and can help speech-language pathologists in their decision-making about whether teachers must or must not be restricted in their vocal activities at work.

The Relationship Between Dysphonia Severity Index and Voice-Related Quality of Life in the Elementary School Teachers with Voice Complaint.

INTRODUCTION: Teachers are one of the largest groups of professional voice users who are highly dependent on their voice in their working environment using their voice as a primary tool for their profession. Thus, they are at high risk of voice disorders. Since voice disorders are multi-causal in nature, it is necessary to evaluate them systematically and in different ways to determine the exact nature of the disorder. Therefore, in this study, the relationship between Voice-Related Quality of Life (VRQOL) and Dysphonia Severity Index (DSI) was examined from the perspective of teachers with voice complaint. METHOD: In this study, 157 primary school teachers with voice complaint (49 males and 108 females) with an average age of 38.54 ± 9.56 years were studied using DSI and VRQOL as a self-assessment. RESULTS: The mean of VRQOL was 74.379 ± 18.95 and the mean of DSI was 1.339 ± 1.62. The results of the study showed that there is a significant positive correlation between the overall scores of DSI and VRQOL scales (r = 0.545, P < 0.001). CONCLUSION: This study showed that a low dysphonia severity index, reflecting poor laryngeal function, is associated with lower voice-related quality of life. Therefore, accurate and timely assessment of the DSI in teachers can prevent the occurrence and/or progression of voice disorder and, consequently, prevent reducing the voice-related quality of life in teachers.

The Dysphonia Severity Index as a Mediator for the Relationship Between the Vocal Fatigue Index and the Voice-Related Quality of Life Among Elementary Teachers with Voice Complaint.

INTRODUCTION: The multi-causal nature of voice disorders is required to be evaluated systematically and in different ways to determine the exact nature of the disorder. Given the importance of voice for teachers, the present study was designed to investigate the causal relationship between vocal fatigue index (VFI) and the voice-related quality of life (VRQOL) with the mediating role of the dysphonia severity index (DSI) among teachers with voice complaints. METHOD: This analytical and non-interventional study examined 57 male and 122 female teachers with voice complaint. The study used DSI, VRQOL and VFI. Acoustic data were extracted using Praat software, and statistical analysis was performed using SPSS. Direct and indirect path testing of the proposed research model was performed using path analysis and bootstrapping, respectively. RESULTS: Model fit indices showed that the proposed model is data fit (CFI = 0.998, GFI = 0.996, RMSEA = 0.072). Moreover, all subtests of the VFI had a significant direct relationship with VRQOL. The DSI, measured using the proposed model, does not have a significant relationship with VRQOL. Therefore, the indirect path of the present model (including tiredness of voice to VRQOL through DSI, physical discomfort to VRQOL through DSI and the improvement of symptoms with rest to VRQOL through DSI) did not show a significant relationship. CONCLUSION: The vocal fatigue directly affects VRQOL. However, it does not affect it indirectly through DSI. Therefore, it can be concluded that although DSI and VRQOL are correlated, they do not have a causal relationship and DSI, as an acoustic parameter, cannot be an appropriate mediator for the relationship between the VFI and VRQOL.

Effect of FFP2/3 Masks on Voice Range Profile Measurement and Voice Acoustics in Routine Voice Diagnostics.

INTRODUCTION: Voice diagnostics including voice range profile (VRP) measurement and acoustic voice analysis is essential in laryngology and phoniatrics. Due to COVID-19 pandemic, wearing of 2 or 3 filtering face piece (FFP2/3) masks is recommended when high-risk aerosol-generating procedures like singing and speaking are being performed. Goal of this study was to compare VRP parameters when performed without and with FFP2/3 masks. Further, formant analysis for sustained vowels, singer's formant, and analysis of reading standard text samples were performed without/with FFP2/3 masks. METHODS: Twenty subjects (6 males and 14 females) were enrolled in this study with an average age of 36 ± 16 years (mean ± SD). Fourteen patients were rated as euphonic/not hoarse and 6 patients as mildly hoarse. All subjects underwent the VRP measurements, vowel, and text recordings without/with FFP2/3 mask using the software DiVAS by XION medical (Berlin, Germany). Voice range of singing voice, equivalent of voice extension measure (eVEM), fundamental frequency (F0), sound pressure level (SPL) of soft speaking and shouting were calculated and analyzed. Maximum phonation time (MPT) and jitter-% were included for Dysphonia Severity Index (DSI) measurement. Analyses of singer's formant were performed. Spectral analyses of sustained vowels /a:/, /i:/, and /u:/ (first = F1 and second = F2 formants), intensity of long-term average spectrum, and alpha-ratio were calculated using the freeware praat. RESULTS: For all subjects, the mean values of routine voice parameters without/with mask were analyzed: no significant differences were found in results of singing voice range, eVEM, SPL, and frequency of soft speaking/shouting, except significantly lower mean SPL of shouting with FFP2/3 mask, in particular that of the female subjects (p = 0.002). Results of MPT, jitter, and DSI without/with FFP2/3 mask showed no significant differences. Further mean values analyzed without/with mask were ratio singer's formant/loud singing, with lower ratio with FFP2/3 mask (p = 0.001), and F1 and F2 of /a:/, /i:/, /u:/, with no significant differences of the results, with the exception of F2 of /i:/ with lower value with FFP2/3 mask (p = 0.005). With the exceptions mentioned, the t test revealed no significant differences for each of the routine parameters tested in the recordings without and with wearing a FFP2/3 mask. CONCLUSION: It can be concluded that VRP measurements including DSI performed with FFP2/3 masks provide reliable data in clinical routine with respect to voice condition/constitution. Spectral analyses of sustained vowel, text, and singer's formant will be affected by wearing FFP2/3 masks.

The effects of Cricothyroid Visor Maneuver (CVM) therapy on the voice characteristics of patients with muscular tension dysphonia: A Case Series Study.

OBJECTIVE: The purpose of this study was to assess the effects of a novel manual therapy, the Cricothyroid visor maneuver (CVM) therapy, on acoustic, auditory perceptual and self-assessment ratings in Muscle tension dysphonia (MTD) patients. STUDY DESIGN: This was a retrospective study of 6 clinical cases. MATERIALS AND METHOD: The study comprised 6 Persian speakers with MTD (2 men and 4 women) and mean age 38.50 ± 5.32 years. All patients underwent therapy between April and June 2021. Therapy was provided in five 30-minute sessions. This study used of acoustic measurement including smoothed cepstral peak prominence (CPPs), Dysphonia Severity Index (DSI), self-assessment scales include vocal tract discomfort scale (VTD), voice related quality of life (V-RQOL) and Consensus Auditory- Perceptual Evaluation of Voice (CAPE-V) for auditory perceptual assessment in pre- and post-CVM sessions. RESULTS: In the present study the CPPs and DSI increased while only CPPs significantly changed in pre and post therapy (P < 0.05). Also, having done the therapy the total severity of dysphonia (CAPE-V) and VTD significantly decreased (P < 0.05) and V-RQOL significantly increased (P < 0.05). CONCLUSIONS: These results suggest that CVM can be an effective method for promote significant improvements in acoustic measurements, auditory perceptual and self-assessment scales in patients with MTD.

Relation Between Dysphonia Severity Index (DSI) and Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V).

OBJECTIVES: This study aims to conduct a relationship survey between subjective voice assessment (the Persian version of consensus auditory perceptual evaluation of voice (called ATSHA)) and the Dysphonia Severity index (DSI). STUDY DESIGN: Cross-sectional, methodological study. METHODS: Our sample included 144 adults; 48 patients with different voice disorders and 96 volunteers without voice disorders, hearing complaints or any auditory-perceptual voice disorders. The vocal tasks included in the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) and the DSI were performed and recorded. We used subjective and objective assessments to investigate the correlation between the CAPE-V perceptual-auditory assessment parameters and the DSI. Finally, through using the univariate-linear regression and other statistical analyses, we examined the correlation and prediction value of subjective assessment by the DSI. RESULTS: The result of correlation of the total DSI value and individual items with the CAPE-V parameters demonstrated the strongest correlation between the DSI and breathiness (R = 0/563) in the second sentence of the CAPE-V scale, and the weakest correlation between the DSI and overall severity (R = 0/202) in the sixth sentence. The results of the univariate linear regression model indicated that the highest predictive power was obtained for the DSI and breathiness (R2 = 0/427) in the sixth sentence in the dysphonic group, while the lowest predictive power was found for low intensity and strain (R2 = 0/025) in the connected speech in the control group. CONCLUSION: This study found a significant relationship between the target objective and subjective voice assessment scales in most parameters. Furthermore, the findings of the current study show that the DSI scale, as an objective tool, can predict some auditory-perceptual parameters.

Effect of Muscle Tension Dysphonia on Self-perceived Voice Handicap and Multiparametric Measurement and Their Relation in Female Teachers.

OBJECTIVES: Muscle tension dysphonia (MTD) is a common voice disorder in teachers in which subjective and objective dimensions of quality of voice can be impaired. The study aimed to compare voice handicap index (VHI) and dysphonia severity index (DSI) in teachers with and without MTD as well as study correlation between them. STUDY DESIGN: Cross-sectional survey. METHOD: Fifty female teachers were enrolled in the study in two different groups (1) twenty-five teachers with MTD (with mean age of 42.62 ± 3.58 years) and (2) 25 teachers without MTD (with mean age of 44.50 ± 3.49 years). All participants completed the Persian version of VHI and underwent multiparametric measurement of voice by the DSI; these subjective and objective voice measures were compared between two groups and their relation was studied. RESULTS: There was significant difference in the VHI, DSI, and their components in teachers with and without MTD (P < 0.05). No significant correlation was found between the total score of VHI and DSI score in the teachers with MTD (rPearson: 0.04, p: 0.82), although there was significant correlation between them in the teachers without MTD (rPearson: -0.75, p: 0.001). CONCLUSION: Teachers with MTD demonstrated higher voice handicap and lower voice quality compared to the teachers without MTD. Moreover, dysphonia interrupted relation between the results of self-perceived evaluation and multiparametric measurement of voice in the teachers with MTD in while these assessments were parallel in the healthy teachers. Further studies are recommended to transparent relation between objective and subjective voice assessments in healthy population.

Effect of Age and Gender on Acoustic Voice Quality Index Across Lifespan: A Cross-sectional Study in Indian Population.

BACKGROUND: The human voice is dynamic and changes throughout the life span. The effects of age and gender on acoustical measures of voice quality have been well established. Assessment of voice quality using multiparametric measures has been recommended over singleton measures. Acoustic Voice Quality Index (AVQI), which is a multiparametric measure of voice quality, has gained popularity in the recent past. Studies investigating the effect of age on AVQI are very limited especially across the life span. The majority of the studies involving AVQI have been carried out in the European and East Asian populations. There is a dearth of studies involving AVQI in the Indian population. OBJECTIVES: The present study was taken up to investigate the effects of age, gender on the AVQI version 02.02 in the Indian population. The present study also aimed to establish reference data for AVQI in the Indian population. METHOD: AVQI and its constituent parameters were obtained from a total of 200 participants (50 pediatrics, 100 adults and 50 older adults) with an equal number of males and females. Multivariate Analysis of Variance was carried out to check the significant differences across age group and gender for AVQI and its constituent parameters along with interaction effects. RESULTS: AVQI values obtained from the Indian population were slightly higher than those reported in the earlier literature for the European and East Asian populations. AVQI obtained by pediatric and older adult groups was found to be significantly higher when compared to that of adults. Significant age effects were also demonstrated by AVQI. The values of AVQI were found to be more stable in adults than in pediatric and older adult groups. AVQI values did not differ significantly across older adult and pediatric groups. Gender effects were not observed in AVQI. CONCLUSION: This is the first study to report changes in AVQI across the lifespan in the Indian population. The present study adds on to the literature the reference measures of AVQI for the Indian population. Findings of the present study suggest that age can have an impact on AVQI v.02.02 values; even though it is independent of gender.

Effect of Gender on Acoustic Voice Quality Index 02.03 and Dysphonia Severity Index in Indian Normophonic Adults.

Acoustic Voice Quality Index and Dysphonia Severity Index are the two most widely used multiparametric objective measures that can successfully quantify voice quality. Latoszek et al. (2019) reported that gender had no influence on both AVQI and DSI in Dutch population. However, there is a lack of research focussed on investigating the gender effect on both DSI and AVQI and on investigating the relationship between DSI and AVQI in the Indian adult population. The present study is aimed to investigate the effect of gender on DSI and AVQI and to explore the relation between the two in the Indian adult population. 138 normophonic individuals (74 females and 64 males) were considered as participants. The phonation of /a/ and reading samples were considered as stimuli for extracting AVQI analysed using AVQI script version 02.03. The raw values of MPT, highest frequency, lowest intensity, and Jitter% were obtained from VRP module and MDVP module of Computerized Speech Lab to calculate the DSI. The results revealed that gender has significant effect on CPPs, HNR and TiltLTAS, ShimLocal, ShimdB, MPT, F0-High and Jitter%. While the overall AVQI, DSI, SlopeLTAS and I-Low were independent of gender effect. To conclude, the present study provides the reference data for AVQI v.2.03 and DSI for healthy Indian adults and discusses the influence of gender on AVQI, DSI and their constituent parameters.

Dysphonia Severity Index and Consensus Auditory-Perceptual Evaluation of Voice Outcomes, and Their Relation in Hospitalized Patients with COVID-19.

OBJECTIVES: This study aimed to compare the results of the Dysphonia Severity Index (DSI) and Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) between patients hospitalized with COVID-19 and healthy subjects, as well as to investigate the correlation between DSI and CAPE-V. STUDY DESIGN: Cross-sectional survey. MATERIAL AND METHODS: Eighty subjects, 40 COVID-19 patients (with a mean age of 41.2± 5.41) and 40 healthy subjects (with a mean age of 44.50± 3.50) participated in this study. Assessments included the DSI for aerodynamic-acoustic measurement and the Persian version of Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) for evaluating auditory-perceptual voice quality. Data were analyzed by means of the independent t-test and Pearson correlation at the 5% significance level. RESULTS: The results showed COVID-19 patients got significantly lower score in DSI compared to healthy subjects (P < 0.05). Moreover, the patients with COVID-19 had higher scores in all categories of voice production (severity, roughness, loudness, pitch, strain and breathiness) than the healthy group (P < 0.05). Comparing the result of the two voice assessments in each group revealed that there was a greater negative significant correlation in the diseased group (r p: -0.68, P: 0.001) than in the healthy group (r p: -0.37,P: 0.049). CONCLUSIONS: Hospitalized COVID-19 patients experience deviations in the voice quality and acoustic-aerodynamic features of their voice. Also, the results of this study showed the patient group had higher perceptual dysphonia and lower voice quality compared to the healthy group. Further studies are recommended to determine the relationship between objective and subjective voice evaluation in patients with COVID-19 after recovery.

The impact of a standardized vocal loading test on vocal fold oscillations.

INTRODUCTION: Vocal loading capacity is an important aspect of vocal health and is measured using standardized vocal loading tests. However, it remains unclear how vocal fold oscillation patterns are influenced by a standardized vocal loading task. METHODS: 21 (10 male, 11 female) vocally healthy subjects were analyzed concerning the dysphonia severity index (DSI) and high speed videolaryngoscopy (HSV) on the vowel /i/ at a comfortable pitch and loudness before and after a standardized vocal loading test (10 min standardized text reading, at a level higher than 80 dB (A) measured at 30 cm from the mouth). RESULTS: Changes in DSI were statistically significant, diminishing by 1.2 points after the vocal loading test, which was mainly caused by an increase of the minimum intensity. However, the pre-post comparison of HSV derived measures failed to show any statistically significant changes. CONCLUSION: It seems necessary to analyze the effects of a standardized vocal loading test on vocal fold oscillation patterns with respect to softest phonation and phonation threshold pressure rather than comfortable pitch and loudness. Level of evidence 2c.

A Study of Vocal Facilitating Techniques Compared to Manual Circumlaryngeal Therapy in Teachers With Muscle Tension Dysphonia.

OBJECTIVE: There are several voice therapy techniques been suggested in patients with muscle tension dysphonia (MTD), however a few studies are compared between them. The purpose of present study was to compare the effect of vocal facilitating techniques (VFTs) and manual circumlaryngeal therapy (MCT) in teachers with MTD. STUDY DESIGN: This is a randomized clinical trial study. METHODS: Sixteen teachers with MTD (female; mean age: 38.6 ± 4.6 years) participated in this study. The participants allocated to two treatment groups: the first group received VFTs (n: 8) and MCT was presented to the second one (n: 8). In each group, the voice therapy techniques were given for 10 individual sessions twice a week. The effect of both techniques was assessed using voice handicap index (VHI) and dysphonia severity index (DSI). RESULTS: Within group comparison, the VHI, DSI, and theirs components showed significantly better results after both treatment groups (P ≤ 0.05). Although, effect size was strong for all target features (η2 > 0.36); the greatest magnitude was obtained on the physical subscale of VHI following MCT and for the DSI after VFTs (η2 = 0.92 and 0.90, respectively). Moreover, the interactive effect of time and treatment groups indicated that there was significant main effect on the physical and functional subscales of VHI (P = 0.00 and 0.02, respectively) as well as I-low and DSI (P = 0.01 and 0.02, respectively). CONCLUSION: VFTs and MCT are two effective techniques in voice therapy of teachers with MTD. However, the greatest improvement obtained on the DSI following VFTs and for the physical aspect of VHI after MCT demonstrated voice therapist can use appropriate technique based on the voice complaints and results of voice assessments in MTD.