Cross-cultural adaptation of the Iranian Voice Quality of Life Profile into Brazilian Portuguese. / Adaptação transcultural para o Português Brasileiro do Perfil de Qualidade de Vida relacionado a Voz.

PURPOSE: To cross-culturally adapt the Voice Quality of Life Profile (IVQLP) into Brazilian Portuguese (BP). METHODS: The cross-cultural adaptation process was performed in five stages: translation of the IVQLP into BP by three native BP experts fluent in American English; preparation of a consensus version; back-translation by a native American English expert fluent in BP; analysis by a committee of five experts and preparation of the final version of the instrument in BP, which was named IVQLP-Br; and pre-testing. The IVQLP-Br aims to assess the impacts of the voice more comprehensively, encompassing various areas of an individual's life. It has 43 items and a five-level response key. For the pre-test, the alternative "not applicable" was added as a response option. Thirty-six adults with self-reported risk of dysphonia participated in the pre-test. RESULTS: In the translation stage, ten items were modified, and during the back-translation, 15 items required adjustments. No questions required reformulation after the application of the IVQLP-Br in the target population, because the option "not applicable" appeared in 12 responses without statistical significance. CONCLUSION: The version of the IVQLP translated into BP, named the IVQLP-Br, exhibited cross-cultural equivalence and was administrable for a more detailed analysis of the impact of the voice in different domains of an individual's life. After validation, the IVQLP-Br will be able to contribute both to clinical practice and to research with BP speakers.

OBJETIVO: Traduzir e adaptar de forma transcultural o Iranian Voice Quality of Life Profile (IVQLP) para o português brasileiro (PB). MÉTODO: O processo de adaptação transcultural foi realizado por meio de cinco etapas: tradução do IVQLP para o PB por três especialistas nativos do PB e fluentes no inglês americano; elaboração de uma versão de consenso; retrotradução por um especialista nativo do inglês americano e fluente no PB; análise por um comitê de cinco especialistas e elaboração da versão final do instrumento em PB, denominado IVQLP-Br; e pré-teste. O IVQLP-Br tem o objetivo de avaliar os impactos da voz de uma forma mais abrangente, englobando vários domínios da vida dos indivíduos, apresenta 43 itens e uma chave de respostas de cinco pontos. Para o pré-teste foi acrescida como opção para o respondente a alternativa "não aplicável". Participaram do pré-teste 36 indivíduos adultos com risco autorrelatado para disfonia. RESULTADOS: Na etapa de tradução 10 itens foram modificados e na retrotradução, 15 itens necessitaram de ajustes. Nenhum item precisou ser reformulado após a aplicação na população-alvo, pois a opção "não aplicável" apareceu em doze respostas, porém, sem significância estatística. CONCLUSÃO: Conclui-se que a versão traduzida do IVQLP para o PB, denominado IVQLP-Br, apresentou equivalência transcultural e pode ser utilizada para uma análise mais detalhada do impacto da voz nos diferentes domínios da vida dos indivíduos. Após a validação, o IVQLP-Br poderá contribuir tanto para a prática clínica, quanto para pesquisas com falantes do PB.

Adaptação transcultural para o Português Brasileiro do Perfil de Qualidade de Vida relacionado a Voz / Cross-cultural adaptation of the Iranian Voice Quality of Life Profile into Brazilian Portuguese

RESUMO Objetivo Traduzir e adaptar de forma transcultural o Iranian Voice Quality of Life Profile (IVQLP) para o português brasileiro (PB). Método O processo de adaptação transcultural foi realizado por meio de cinco etapas: tradução do IVQLP para o PB por três especialistas nativos do PB e fluentes no inglês americano; elaboração de uma versão de consenso; retrotradução por um especialista nativo do inglês americano e fluente no PB; análise por um comitê de cinco especialistas e elaboração da versão final do instrumento em PB, denominado IVQLP-Br; e pré-teste. O IVQLP-Br tem o objetivo de avaliar os impactos da voz de uma forma mais abrangente, englobando vários domínios da vida dos indivíduos, apresenta 43 itens e uma chave de respostas de cinco pontos. Para o pré-teste foi acrescida como opção para o respondente a alternativa "não aplicável". Participaram do pré-teste 36 indivíduos adultos com risco autorrelatado para disfonia. Resultados Na etapa de tradução 10 itens foram modificados e na retrotradução, 15 itens necessitaram de ajustes. Nenhum item precisou ser reformulado após a aplicação na população-alvo, pois a opção "não aplicável" apareceu em doze respostas, porém, sem significância estatística. Conclusão Conclui-se que a versão traduzida do IVQLP para o PB, denominado IVQLP-Br, apresentou equivalência transcultural e pode ser utilizada para uma análise mais detalhada do impacto da voz nos diferentes domínios da vida dos indivíduos. Após a validação, o IVQLP-Br poderá contribuir tanto para a prática clínica, quanto para pesquisas com falantes do PB.

ABSTRACT Purpose To cross-culturally adapt the Voice Quality of Life Profile (IVQLP) into Brazilian Portuguese (BP). Methods The cross-cultural adaptation process was performed in five stages: translation of the IVQLP into BP by three native BP experts fluent in American English; preparation of a consensus version; back-translation by a native American English expert fluent in BP; analysis by a committee of five experts and preparation of the final version of the instrument in BP, which was named IVQLP-Br; and pre-testing. The IVQLP-Br aims to assess the impacts of the voice more comprehensively, encompassing various areas of an individual's life. It has 43 items and a five-level response key. For the pre-test, the alternative "not applicable" was added as a response option. Thirty-six adults with self-reported risk of dysphonia participated in the pre-test. Results In the translation stage, ten items were modified, and during the back-translation, 15 items required adjustments. No questions required reformulation after the application of the IVQLP-Br in the target population, because the option "not applicable" appeared in 12 responses without statistical significance. Conclusion The version of the IVQLP translated into BP, named the IVQLP-Br, exhibited cross-cultural equivalence and was administrable for a more detailed analysis of the impact of the voice in different domains of an individual's life. After validation, the IVQLP-Br will be able to contribute both to clinical practice and to research with BP speakers.

The Effect of Adding Cricothyroid Visor Maneuver to Voice Facilitating Techniques on Improving Voice in Individuals With Primary Muscle Tension Dysphonia: A Pilot Randomized Clinical Trial.

OBJECTIVES: The purpose of the present study was to examine the effect of adding a cricothyroid visor maneuver to conventional voice-facilitating techniques on voice quality and reported symptoms in patients with primary muscle tension dysphonia. METHODS: This was a double-blind two parallel-group clinical trial in which 20 adult patients participated through convenience sampling. Participants were allocated to intervention (combined treatment) and control (conventional treatment) groups. The intervention was performed for both groups for five sessions, twice a week. The two groups were compared after the intervention for primary outcome measures including maximum phonation time, jitter, shimmer, harmonic-to-noise ratio, and consensus auditory-perceptual evaluation of voice, and for secondary outcome measures including the voice handicap index, the voice activity and participation profile, the voice-related pain scale, and the vocal tract discomfort scale. RESULTS: Within-group primary outcome comparison showed that both groups showed significant improvement in maximum phonation time and consensus auditory-perceptual evaluation of voice indices after treatment. the between-group comparison showed that the maximum phonation time increased significantly in the intervention group after the treatment (P = 0.03) and the effect size was large (es = 1.05). within-group secondary outcome comparison showed that all indices improved significantly in both groups except for the voice-related pain scale frequency. The between-group comparison showed that except for voice-related pain scale frequency, the intervention group reported significantly more improvement in all other self-reporting indices with a large effect size. CONCLUSIONS: The study showed that adding cricothyroid visor maneuver to conventional voice-facilitating techniques, compared to conventional treatment alone, resulted in a significant increase in maximum phonation time, reduction in pain and vocal tract discomfort, increase in activity and participation, and improvement in voice-handicapped index in primary muscle tension dysphonia patients. Therefore adding cricothyroid visor maneuver to other treatments can be an effective method in improving primary muscle tension dysphonia which needs more studies in the future.

Chronic voice disorder after coronavirus disease 2019 infection and its treatment using the cricothyroid visor maneuver: a case report.

BACKGROUND: Regarding human coronavirus, the severe acute respiratory syndrome coronavirus 2 pandemic, the novelty of disease, and consequently the lack of studies, the etiology of dysphonia in patients with coronavirus disease 2019 is still unknown and needs to be investigated. The purpose of the current study is to investigate the effect of a new manual therapy technique, cricothyroid visor maneuver, on muscle tension dysphonia symptoms for a patient who had experienced dysphonia symptoms due to the coronavirus disease 2019 infection. CASE PRESENTATION: A 55-year-old retired Iranian teacher who was diagnosed with muscle tension dysphonia by an otolaryngologist participated in this study. Fifty days before being referred to an otolaryngologist, he was diagnosed with coronavirus disease 2019 on the basis of the results of a standard laboratory test, namely real-time polymerase chain reaction. Treatment was provided in ten sessions. Pre- and post-treatment audio recordings of sustained vowels, selected sentences, and connected speech samples were submitted for auditory perceptual and acoustic analysis to assess the effects of the treatment program. Also, videolaryngostroboscopy voice quality perceptions by the patient, both before and after therapy, were assessed. The reduction in all features of the Consensus Auditory-Perceptual Evaluation of Voice was observed. The results of acoustic assessment showed that jitter (35.13%) and shimmer (20.48%) decreased; moreover, the harmonics-to-noise ratio (1.17%), cepstral peak prominence smoothed (28.53%) and maximum phonation time (15.5%) increased after treatment sessions. The scores of four parameters of Stroboscopy Examination Rating Form (SERF) form changed after cricothyroid visor maneuver therapy. Also, the visual analog scales score at the pre-treatment assessment was 40, and increased to 90 at the post-treatment assessment. CONCLUSIONS: The effectiveness of cricothyroid visor maneuver therapy on dysphonia associated with coronavirus disease 2019 was investigated in the current study. This case study has highlighted chronic dysphonia after coronavirus disease 2019 infection, and suggests that the cricothyroid visor maneuver therapy approach may have positive outcomes for patients with muscle tension dysphonia with this background.

Outcomes of Cricothyroid Visor Maneuver (CVM) for Treatment of Vocal Polyp: A Case Report.

OBJECTIVE: The aim of the study is the clinical investigation of a patient with a vocal fold polyp, and the visual, acoustical, perceptual, and self-report changes before and after using the cricothyroid visor manoeuvre (CVM). DESIGN: A 48-year-old female university professor, gynecologist, and obstetrician with a history of laryngopharyngeal reflux and a left vocal polyp participated. Treatment was provided in 10 sessions. Pre- and post-treatment audio recordings of sustained vowels, selected sentences, and connected speech samples were submitted to auditory-perceptual and acoustical analysis to assess the effects of the two-treatment program. Also, laryngoscopic images, perceptions by the patient about her voice quality and quality of life before and after therapy were assessed. RESULTS: Improvements in acoustic parameters were obtained especially in perturbation and CCPS parameters. The overall voice quality scores on the CAPE-V were moderate before therapy and became mild after therapy. Laryngoscopy images demonstrated improvement in the glottis closure configuration in two phases (open and close) in pre- and post- CVM therapy and a decrease in polyp size. The patient had improvement in VAS, IVQLP, and VRQOL scores. CONCLUSION: The CVM therapy used in the study resulted in positive changes in acoustic and perceptual-auditory aspects of voice production, self-report, and QOL for the patient. The CVM approach appears to have been effective for this case in decreasing the polyp size or its regression or for vocal adaptation.

Construct and Discriminant Validity of the Persian Version of the Consensus Auditory Perceptual Evaluation of Voice (CAPE-V).

PURPOSE: Five dimensions of voice assessment are considered as visual evaluation, videostroboscopy, acoustic, aerodynamic, patient-based, and auditory-perceptual. Auditory-perceptual voice assessment scales are the standard scales for clinicians to document voice therapy outcomes in dysphonic patients. The primary objective of the present study was to investigate the construct and discriminant validities of the Persian Version of the CAPE-V (ATSHA). A secondary objective was to determine the differences between experienced and inexperienced raters in the auditory-perceptual assessment of voice. METHOD: Forty normal and forty individuals with dysphonia were rated by five experienced and five inexperienced raters. Pathological subgroups were vocal fold nodules, vocal fold polyps, unilateral vocal fold paralysis (UVFP), and Reinke's edema. The differences between normal and pathologic groups were observed by independent t tests for all perceptual parameters (P < 0.05). Construct validity was documented for the scale of interest. The Kruskal-Wallis and Mann-Whitney comparisons were used to examine discriminant validity. RESULTS: Findings of these tests showed that scores of all pathological subgroups were significantly different except for the parameter of "strain" in sustained vowels (P < 0.05). Results of the Wilcoxon Matched-Pairs Signed Rank Test indicated that experienced and inexperienced raters were significantly different in auditory-perceptual judgments of voice. CONCLUSION: It seems that the Persian Version of the CAPE-V is a consistent predictor of normal and pathological voices. Moreover, we found that experienced listeners have different auditory-perceptual skills in evaluation of voice that make them more precise than inexperienced listeners.

A Cepstral Peak Prominence (CPP) Voice Analysis in Iranian Post-lingual Deaf Adult Cochlear Implant Users.

OBJECTIVE: In standardized connected speech samples, cepstral peak prominence (CPP) and smoothed CPP (CPPS) have been described as accurate parameters to evaluate voice quality. Lack of normal auditory feedback in post-lingually deaf CI users might influence tuning the acoustic parameters in speech production. Based on shreds of evidence, normal hearing results in suitable vocal control through the sensory-motor linkage. The main aim of the present study was to compare the cepstral values between the Iranian cochlear implant group and normal peers. METHOD: Persian CAPE-V sentences were recorded from 30 CI users and 30 healthy speakers (mean age=36.7 years, SD=13.5, range=18-60 years). Thirteen /a/vowels were extracted manually from syllables. Each subject phonated sustained /a/vowel for 5 seconds. PRAAT was used to calculate CPP and CPPS. To compare two age- and gender-matched groups, the independent sample t-test was applied. Then, ANCOVA was used to assess the impact of demographic factors on cepstral scores in CI participants. RESULTS: Significant differences between the CI group and normal peers were discovered based on CPP and CPPS in both tasks (reading sentences and sustained vowel) (P < 0.05). Overall, CI users showed higher cepstral values. The implanted ear and prosthesis model had no significant impact on both CPP and CPPS (P ≥ 0.8). CONCLUSION: Higher CPP and CPPS values in the CI users might be due to increased phonatory instability and spectral noise, with the possibility of decreased vocal control and its quality. The outcome suggests that CI group uses a different voice control strategy. These findings should be kept in mind for intervention methods, especially by assessing vocal characteristics and considering the voice quality in adult CI users.

Comparison of vocal fatigue and vocal tract discomfort between teachers of normal pupils and teachers of mentally disabled pupils.

PURPOSE: This study aims to study the comparison of vocal fatigue and vocal tract discomfort between teachers of normal pupils and teachers of mentally disabled pupils. STUDY DESIGN: Cross-sectional study METHODS: Participants were 179 teachers (50 male, 129 female) and 30 non-teachers (14 male, 16 female) who participated in the current study. The teachers work in elementary schools. Furthermore, 87 of the teachers work for mentally disabled pupils at special elementary schools. Non-teachers were Ahvaz Jundishapur University of Medical Sciences employees who consider as the control group. They completed the Persian VFI and VTDp questionnaires three times, at the beginning, middle, and end of their office hours for 1 workday. RESULTS: The current study's findings indicate that the Persian VFI and VTD scores of non-teachers were significantly lower than teachers' scores. Furthermore, teachers of mentally disabled pupils demonstrated higher values from teachers of normal pupils based on the Persian VFI and VTDp scores CONCLUSION: The study results showed that teachers experienced more vocal fatigue and vocal tract discomfort than non-teachers. Furthermore, teachers of mentally disabled pupils indicated more vocal fatigue, the larynx's physical discomfort, and vocal tract discomfort, but this difference was practically small.

An evaluation of Short-term Treatment Outcomes of Cricothyroid Visor Maneuver: A Proof-of-Concept Pilot Study.

INTRODUCTION: Muscle tension dysphonia (MTD) is used as a clinical and diagnostic descriptive label for a diverse range of vocal fold behaviors caused by increased tension of the (para) laryngeal musculature. These increased tension can occur in the cricothyroid muscle and in the ''visor'' mechanism, contributing to voice problems. The main goal of this study is to determine whether a new method, the cricothyroid visor maneuver (CVM), is an effective method for improving quality and other aspects of the MTD patients' voices. METHOD(S): Eighty-eight adult female patients participated in this quasiexperimental study. One group consisted of 30 MTD patients (mean age 28.7 ± 4.95 years) for whom manual circumlaryngeal therapy (MCT) was provided. The other group consisted of 30 MTD patients (mean age 28.9 ± 5.1 years) who received CVM. Also, 28 adult females with MTD (mean age 28.60 ± 4.56 years), who were on the clinic's waiting list, served as a control group and did not receive any treatment. Treatment was provided in a single 30-minute session. Pre- and post-treatment audio recordings of sustained vowels, selected sentences, and connected speech samples were submitted to auditory-perceptual and acoustical analysis to assess the short-term effects of the two treatment programs. Also, perceptions of patients' about their voice quality before and after therapy were assessed by visual analogue scale. RESULTS: Perceptually, Consensus Auditory Perceptual Evaluation of Voice (CAPE-V) ratings improved in all patients with both treatment methods. Acoustically, with CVM, harmonic-to-noise ratio and Cepstral Peak Prominence increased and perturbation (jitter and shimmer) measures decreased and there was not significant change in MCT and control groups. Visual analogue scale showed that feelings of patients improved after therapy in both treatment methods, with higher scores for patients receiving CVM in comparison to the MCT method. DISCUSSION: These results suggest that CVM can be an effective method for voice rehabilitation in patients with MTD and manipulation of Cricothyroid muscle and ''visor'' mechanism can lead to marked voice improvement.

Persian Translation, Validation and Reliability of the Voice Handicap Index-Throat (VHI-T).

OBJECTIVE: The aim of the present study is to validate, and assess the reliability of the Persian version of Voice Handicap Index-Throat (VHI-Tp) as a self-reported questionnaire for patients with throat problems that could make the patients' estimation of the throat discomforts possible. It is a subscale to be used independently. STUDY DESIGN: This is a cross-sectional study. MATERIALS AND METHOD: During this study, the VHI-Tp was administered to120 patients with throat problems related to laryngeal discomfort (51 male and 69 female, age range: 30-60 years).The diagnosis of Voice disorder was performed by an ENT physician based on video-laryngoscopy evidences and medical examination. To assess the content validity, the questions were first given to 15 experts to comment on content applicability and relevance through a Likert scale. Eighty patients rated its importance to detect face validity. To evaluate the concurrent validity, the same 80 patients completed both the VHI-Tp as well as the Persian version of Voice Symptom Scale. The VHI-Tp total scores of the patients with diagnosed throat problem related to laryngeal discomfort and of the 40 healthy participants were compared to test the clinical validity (discriminant validity). Also, internal consistency reliability was assessed using Cronbach α coefficient. The relative reliability was calculated by asking 40 of all patients out of the 80 participants, to complete the VHI-Tp twice, with a week of interval between the first and the second times. To detect the absolute reliability, Standard Error of Measurement and Smallest Detected Change were calculated. RESULTS: Discriminative validity differed significantly between patients and healthy participants. There was a significant correlation between the VHI-Tp and Voice Symptom Scale total scores (r = 0.6, P < 0.05). The internal consistency was confirmed (Cronbach α = 0.78). The test-retest reliability was excellent (intraclass correlation coefficient = 0.95).The Standard Error of Measurement and Smallest Detected Changes were acceptable (0.39 and 1.08), respectively. CONCLUSION: The Persian version of the VHI-T was demonstrated to be a valid and reliable self-rated questionnaire for use in Persian patients with throat problem related to laryngeal discomfort.

Voice Changes During Pregnancy Trimesters in Iranian Pregnant Women.

OBJECTIVE: This study aimed to evaluate the vocal changes in the Iranian pregnant women according to trimesters both objectively and subjectively. METHODS: There were 93 pregnant women and 31 non-pregnant women participants in the study. Thirty-three of the 93 pregnant women were in their first trimester, 31 in their second trimester, and 29 in their third trimester of their pregnancies. Clinical data were collected from the acoustic measurements, aerodynamic assessment, video laryngoscopy examination, and the self-assessment of quality of life related to voice using the Persian Voice Handicap Index (VHIP). The analysis of variance (ANOVA) test and Kruskal-Wallis test were used for between-group comparisons of the data. RESULTS: Decreased maximum phonation time (MPT), increased S/Z ratio, increased VHIP-30 scores, and evidence of vocal fold edema were the parameters that differed significantly only in the third trimester. Acoustic analysis revealed that F0, jitter, shimmer, and noise-to-harmonics ratio (NHR) were not significant across the four groups. CONCLUSIONS: Results showed that decreased MPT, increased S/Z ratio, mild to moderate edema, and a deterioration of the VHIP-30 score noticeably occurred during the third trimester. The results suggest significant vocal changes toward less stable phonation during the third trimester of pregnancy.

The Singing Voice Handicap Index (SVHI): Validation and Adaptation Into Persian.

OBJECTIVES: The aim of the present study is to develop, validate, and assess the reliability of the Persian version of Singing Voice Handicap Index (SVHIp) as a self-reported questionnaire for singers with voice disorders that measure the patient's self-perceived voice handicap. STUDY DESIGN: This is a cross-sectional study. MATERIALS AND METHOD: During this study, the Persian version of singing voice handicap index was administered to 115 singers (90 male and 25 female, age range: 22-45 years). Voice disorder was confirmed by video-stroboscopic evidences in 48 participants, while 67 were healthy without any voice disorders. To assess the content validity, the prefinal questions were given to 15 experts to comment on its content applicability and relevance through a Likert scale. Seventy five singers rated its importance to detect face validity. To evaluate the concurrent validity, the same 75 participants completed both the SVHIp as well as a visual analog scale. The SVHI total scores of the singers with diagnosed voice disorder and of the healthy singers were compared to test the clinical validity (discriminant validity). Also, internal consistency reliability was assessed using Cronbach α coefficient. The relative reliability was calculated by asking 40 of all singers to complete the SVHIp twice, with a week of interval between the first and the second times. To detect the absolute reliability, Standard Error of Measurement and Smallest Detected Change were calculated. Responsiveness was measured for the Persian version of SVHI by comparing the individual patient scores before and after the treatment. RESULTS: The SVHI was favorably accepted with no deletions. Discriminative validity differed significantly between singers with and without voice disorder. There was a significant correlation between the SVHIp and visual analog scale total scores (P < 0.05). The internal consistency was confirmed (Cronbach α = 0.78). The test-retest reliability was excellent (intraclass correlation coefficient = 0.95). The Standard Error of Measurement and Smallest Detected values were acceptable (0.39 and 1.08), respectively. The Cohens' d effect size indicates the high responsiveness for SVHIp. CONCLUSIONS: The Persian SVHI was demonstrated to be a valid and reliable self-rated questionnaire for use in Persian-singers.

Positive Effects of Manual Circumlaryngeal Therapy in the Treatment of Muscle Tension Dysphonia (MTD): Long Term Treatment Outcomes.

INTRODUCTION: Manual circumlaryngeal therapy (MCT) aims to correct laryngeal position and relax (para) laryngeal and cervical muscles resulting in improved voice quality. The goal of the current study was to further verify long-term effects of MCT in the treatment of Muscle Tension Dysphonia (MTD) patients based on acoustic findings and perceptual judgments. METHOD: Twenty-eight adult female patients who had been referred to the speech therapy clinic of Khatam Hospital, Zahedan city, participated in this study. Manual circumlaryngeal therapy was undertaken. There were 15 therapy sessions, three sessions per week, each with duration of 30 minutes. Pre- and post-treatment audio recordings of sustained vowels, selected sentences, and connected speech samples were submitted to auditory-perceptual and acoustical analysis to assess the long-term (6-months) effects of the 15 treatment program. RESULTS: Acoustically, Harmonic to Noise Ratio (HNR) increased and perturbation (Jitter and Shimmer) measures decreased, and perceptually, the subjective CAPE-V ratings improved in all patients. CONCLUSION: These results suggest that MCT can be an effective method for voice rehabilitation in patients with MTD and the changes due to the therapy were persistent over a 6-month duration following the termination of treatment sessions.

Effects of the Lidcombe Program and Parent-Child Interaction Therapy on Stuttering Reduction in Preschool Children.

PURPOSE: The present study explored the effectiveness of the Lidcombe Program, the parent-child interaction therapy (PCIT) approach, and an integrated (Lid-PCIT) program on the treatment of children who stutter. METHODS: The present research was a single-subject study with an alternative treatment design. Participants were 6 preschool children who were randomly assigned into three groups. Each group received the entire indirect (PCIT), direct (Lidcombe), or integrated (Lid-PCIT) program and were assessed through severity rating (SR), and percent stuttered syllables (%SS), and video analysis. RESULTS: For all children the SR and the %SS were reduced but the percentage of non-overlapping data of the three interventions showed that it was reduced more in the Lidcombe and in the Lid-PCIT programs. CONCLUSIONS: This study provided preliminary evidence that Lidcombe, PCIT, and integrated programs were effective in reducing the SR and the %SS in preschool children who stutter. These results are potentially important as both indirect and direct interventions in the primary years can help children who stutter to overcome their disorder.

Correlation of the Iranian Voice Quality of Life Profile (IVQLP) with Acoustic Measurements across Three Common Voice Disorders.

OBJECTIVES: The Iranian Voice Quality of Life Profile (IVQLP) is a recent culture-based developed tool for assessing the quality of life of dysphonic patients. The research questions addressed here are as follows: (1) Are the correlations between IVQLP scores and values of objective voice measures? (2) Do the correlations differ across the three different voice disorders? METHODS: The subjects were divided into three groups: muscle tension dysphonia (MTD) (n = 62), benign midmembranous vocal fold lesions (n = 56), and unilateral vocal fold paralysis (UVFP) (n = 32). The study sample consisted of 91 males and 59 females. The individuals had a mean age of 46.53 ± 13.84 years. All of the participants completed the IVQLP questionnaire. The PRAAT software was used to provide acoustic analyses. The correlations between fundamental frequency (F0), perturbation analyses, harmonics-to-noise ratio, and IVQLP data of the three groups of patients were measured using Pearson's correlation. RESULTS: There was a significant correlation between the total score and jitter in the MTD group. For the benign vocal fold lesion group, correlations were significant and relatively strong for numerous analyses. Again, there were numerous significant and strong correlations for the UVFP group. CONCLUSIONS: Results may indicate two interpretations. One interpretation of the results is that patients with morphological tissue changes (lesions, paralysis) appear to associate their sense of how their voice problem negatively affects their lives. A second interpretation is that there is perhaps a threshold of vocal perturbation or instability that lends itself to a patient's connection to his or her sense of how the voice affects his or her quality of life.

Correlation of Iranian Voice Quality of Life Profile (IVQLP) to VHI-30 and VRQOL: Construct Validity Evidence.

OBJECTIVES: An important domain in health-related quality of life evaluations is quality of life perceptions due to having a voice disorder. The purpose of the current study was (1) to examine the correlation of the Iranian Voice Quality of Life Profile (IVQLP) with the Voice-Related Quality of Life (VRQOL) and Voice Handicap Index-30 (VHI-30) for establishing the construct convergent validity of the IVQLP, and (2) to examine the correlation between VRQOL and VHI-30. METHODS: Study sample consisted of 150 patients, 91 male and 59 female, diagnosed with muscle tension dysphonia, benign organic disorders such as polyps and nodules, and unilateral vocal fold paralysis. In total, 150 patients aged 46.53 ± 13.84 years completed the IVQLP and Persian versions of the VHI and VRQOL. RESULTS: The results showed that Spearman rank-order correlation coefficient between the results of the VHI and IVQLP questionnaires was 0.90 (P < 0.001). The correlation coefficient between VRQOL and IVQLP was -0.88. (P < 0.001) The Spearman correlation between VHI and VRQOL was -0.94. (P < 0.001) CONCLUSIONS: The current study showed that the IVQLP has good construct validity, and it can evaluate quality of life in Iranian dysphonic patients based on their culture. Also, the VHI-30 and VRQOL correlation was very high.

Iranian Voice Quality of Life Profile (IVQLP): Factor Analysis.

OBJECTIVES: An important domain in health-related quality of life evaluations is quality of life perceptions due to having a voice disorder. The objective of this study was to examine the factor structure of the Iranian Voice Quality of Life Profile (IVQLP) based on Exploratory Factor Analysis and confirmatory factor analysis. METHODS: The study sample consisted of 280 patients (174 males and 106 females) diagnosed with MTD, benign organic disorders such as polyps and nodules, and unilateral vocal fold paralysis and cancer. To evaluate the different dimensions of the IVQLP, a principal component analysis (PCA) was conducted. Confirmatory factor analysis (CFA) was used to investigate the fitting of extracted dimensions and construct validity of the IVQLP. RESULTS: The results showed that the IVQLP has a 4-factor structure. The first factor has 17 items and refers to Emotions. The second factor has 12 items and refers to Individual/Social Relations. The third factor with 6 items refers to Occupation, and the forth with 5 items relates to Psychosomatic characteristics. CONCLUSIONS: The conclusion of this study is that the concept of quality of life in Iranian patients with voice disorders is somewhat different from that of Western patients. This difference can be seen in. the large number of items related to an Emotional factor and the identification of a Psychosomatic factor.

Development and Validation of an Iranian Voice Quality of Life Profile (IVQLP) Based on a Classic and Rasch Rating Scale Model (RSM).

OBJECTIVES: No culture based instrument exists for the people of Iran to measure outcomes of voice disorders. The objective of this study was to develop a statistically and culturally robust tool for assessing voice disorder outcomes in the Iranian population. METHODS: A 65-item assessment tool called the Iranian Voice Quality of Life Profile (IVQLP) was developed after three stages of study. IVQLP measures voice disorder outcomes in four domains: physical, emotional, functional, and cultural. The questionnaire was given to 130 individuals with various voice disorders and 30 control subjects with no vocal pathology. The data obtained were subjected to measures of reliability (internal consistency and test-retest) and validity (content, construct, and concurrent) in the classic sense, as well as examined based on Rasch rating scale model analysis. RESULTS: Results showed that IVQLP had high internal consistency (α = 0.99) and test-retest reliability (r = 0/90). IVQLP differentiated the dysphonic group from the control group. Findings using the classic models suggested adequate construct validity for 43 items of the IVQLP fit the Rasch model. The high Rasch item separation reliability, separation index, and strata statistics for 43 items indicated that IVQLP provided further evidence that the items are reliable and comprehensive representations of quality of life concepts in Iranian people with voice disorders. CONCLUSIONS: This study concludes that IVQLP is a sufficiently reliable and valid tool to measure Iranian patients' perception of their quality of life in respect to their voice problem.

Correlation of VHI-30 to Acoustic Measurements Across Three Common Voice Disorders.

OBJECTIVES: Voice disorders that affect the quality of voice also result in varying degrees of psychological and social problems. The research question here is whether the correlations between Voice Handicap Index (VHI)-30 scores and objective acoustic measures differ in patients with different types of voice disorders. METHODS: The subjects were divided into three groups: muscle tension dysphonia (MTD), benign mid-membranous vocal fold lesions, and unilateral vocal fold paralysis (UVFP). All participants were male. The mean age for the groups were 32.85 ± 8.6 years in the MTD group, 33.24 ± 7.32 years in the benign lesions group, and 34.24 ± 7.51 years in the UVFP group. The participants completed the Persian VHI-30 questionnaire. PRAAT software was used to obtain acoustic analyses. RESULTS: There was a significant correlation between the physical subscale of the VHI-30 and the total score of the VHI-30 and maximum phonation time (MPT) in the MTD group. Also, there was a significant correlation between the total VHI-30 score and the MPT value. There were relatively strong and significant correlations between the physical subscale of the VHI-30 with jitter and shimmer, harmonics-to-noise ratio (HNR) for the group with benign lesions such as nodules and polyps. Also, in this group, there was a significant correlation between the total VHI-30 score and the jitter value. The physical scale had strong and significant correlations between jitter, shimmer, and HNR in the unilateral paralysis group. CONCLUSIONS: Findings suggest that although the VHI-30 and the acoustic measurements of voice provide independent information, they are associated to some extent.

Formant transitions in the fluent speech of Farsi-speaking people who stutter.

PURPOSE: Second formant (F2) transitions can be used to infer attributes of articulatory transitions. This study compared formant transitions during fluent speech segments of Farsi (Persian) speaking people who stutter and normally fluent Farsi speakers. METHODS: Ten Iranian males who stutter and 10 normally fluent Iranian males participated. Sixteen different "CVt" tokens were embedded within the phrase "Begu CVt an". Measures included overall F2 transition frequency extents, durations, and derived overall slopes, initial F2 transition slopes at 30ms and 60ms, and speaking rate. RESULTS: (1) Mean overall formant frequency extent was significantly greater in 14 of the 16 CVt tokens for the group of stuttering speakers. (2) Stuttering speakers exhibited significantly longer overall F2 transitions for all 16 tokens compared to the nonstuttering speakers. (3) The overall F2 slopes were similar between the two groups. (4) The stuttering speakers exhibited significantly greater initial F2 transition slopes (positive or negative) for five of the 16 tokens at 30ms and six of the 16 tokens at 60ms. (5) The stuttering group produced a slower syllable rate than the non-stuttering group. CONCLUSIONS: During perceptually fluent utterances, the stuttering speakers had greater F2 frequency extents during transitions, took longer to reach vowel steady state, exhibited some evidence of steeper slopes at the beginning of transitions, had overall similar F2 formant slopes, and had slower speaking rates compared to nonstuttering speakers. Findings support the notion of different speech motor timing strategies in stuttering speakers. Findings are likely to be independent of the language spoken. Educational objectives This study compares aspects of F2 formant transitions between 10 stuttering and 10 nonstuttering speakers. Readers will be able to describe: (a) characteristics of formant frequency as a specific acoustic feature used to infer speech movements in stuttering and nonstuttering speakers, (b) two methods of measuring second formant (F2) transitions: the visual criteria method and fixed time criteria method, (c) characteristics of F2 transitions in the fluent speech of stuttering speakers and how those characteristics appear to differ from normally fluent speakers, and (d) possible cross-linguistic effects on acoustic analyses of stuttering.