Development of a Voice Handicap Index for Clergymen: An Investigation of Its Validation and Reliability.

OBJECTIVE: This study aims to is to develop a disorder-specific patient-reported outcome measure to be used in Islamic clergymen with voice disorders and to investigate its validity and reliability. METHODS AND PROCEDURES: Employing an exploratory sequential mixed-methods design, this study conducted in two phases. Initially, semistructured interviews were conducted with 10 clergymen experiencing voice disorders. Subsequently, the questionnaire underwent rigorous validation, encompassing content, construct, and criterion validity assessments, in addition to test-retest reliability and internal consistency analyses. The index was administered to a sample of 110 male clergy, including imams, muezzins, and Quran course teachers, with an age range from 19 to 61years. RESULTS: Construct validity was established through factor analysis, resulting in a final 23-item scale categorized into two factors: physical-functional and emotional. Known group validity demonstrated a significant distinction between the study and control groups. Criterion validity reinforced the index's validity, displaying a correlation coefficient of 0.758 between the Voice Handicap Index for Clergymen and the well-established Voice Handicap Index. The questionnaire exhibited commendable internal consistency, with a Cronbach's Alpha (α) coefficient value of 0.971. Test-retest reliability analysis exhibited strong consistency, with a Pearson correlation coefficient of 0.863. CONCLUSIONS: It is recommended that the developed valid and reliable handicap index in the present study be included in the voice assessment batteries of Islamic clergymen with voice complaints with the clinical and research purposes. In future studies, the validity of the questionnaire can be investigated more by examining the difference between the Voice Handicap Index for Islamic Clergymen (CVHI) scores obtained before and after treatment. Identifying a cut-off point that discriminates between dysphonic and normophonic clergymen may allow the use of the CVHI as a screening tool for this population.

The discriminant ability of the eating assessment tool-10 questionnaire to detect residue and aspiration in patients with mixed etiology of dysphagia.

PURPOSE: To investigate the discriminant ability of the eating assessment tool-10 (EAT-10) to detect postswallow residue and aspiration for different consistencies. METHODS: Seventy-two consecutive patients with mixed etiology of dysphagia (42 males and 30 females, mean ± sd age of 60.42 ± 15.82) were included. After completing the EAT-10, Fiberoptic Endoscopic Evaluation of Swallowing (FEES) was performed to assess the efficiency and safety of swallowing for the following consistencies: thin liquid, nectar thick, yogurt, and solid. While swallowing efficiency was evaluated using the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS), the Penetration-Aspiration Scale (PAS) was used to evaluate swallowing safety. RESULTS: The EAT-10 questionnaire significantly identified the patients with residue from those without residue for the following consistencies and anatomic locations: thin liquid residue in the pyriform sinus (cutoff score ≥ 10, p = 0.009), nectar thick residue in the vallecula (cutoff score ≥ 15, p = 0.001), yogurt residue in the vallecula (cutoff score ≥ 15, p = 0.009), yogurt residue in the pyriform sinus (cutoff score ≥ 9, p = 0.015), and solid residue in the vallecula (cutoff score ≥ 13, p = 0.016). However, the same discriminant ability of EAT-10 was not found for detecting aspiration in any consistency. CONCLUSIONS: The EAT-10 questionnaire can be used as an assessment tool to judge swallowing efficiency in patients with mixed etiology of dysphagia, but the same is not evident for swallowing safety.

Investigation of the Cepstral Spectral Acoustic Analysis for Classifying the Severity of Dysphonia.

OBJECTIVES: The advantages of cepstral measurements in the evaluation of dysphonia have been noted in previous studies. However, there is an unclarity regarding the results of cepstral analyzes effect in determining the severity of dysphonia. The aims of this study were to determine the cut-off values of cepstral peak prominence, cepstral peak prominence standard deviation, low frequency/ high frequency ratio, low frequency/high frequency ratio standard deviation, and cepstral spectral index of dysphonia for predicting the voice severity within a Turkish speaking population, as well as to confirm the discriminative power of these cut-off values. MATERIALS METHODS: One hundred ninety-five individuals with voice disorders and an equal number of age and gender-matched individuals without voice disorders were included. Included subjects had visited the Hacettepe University Hospitals Speech and Language Therapy Department for voice evaluation between January 2017 and September 2021. The voice recordings from all participants included the six CAPE-V/Turkish sentences and sustained vowel /a/. Three raters provided auditory perceptual ratings of the voice samples using the GRBAS scale (grade) and overall severity for the CAPE-V/Turkish. Participants were categorized into normal and mild, moderate, and severely dysphonic groups based on the auditory perceptual evaluation. Analysis of Dysphonia in Speech and Voice (ADSV) software was used for cepstral spectral acoustic analysis. RESULTS: In the sustained vowel context, the area under the curve (ROC) for the CSID value was >0.8, except for mild vs. moderate dysphonia groups. In connected speech contexts, the ROC of the CPP value was also >0.8, except for normal vs. mild dysphonia groups. The cut-off values of CPP and CSID demonstrated high sensitivity and specificity for predicting voice severities. CONCLUSION: The cut-off values for the parameters that predicted voice severities showed a significant degree of discriminative power for categorizing voice severities among Turkish-speaking people.

Psychometric properties of the Viking Speech Scale-Turkish version for children with cerebral palsy aged 4-18 years based on live and video-based observation.

BACKGROUND: Speech is the most common method of communication. Video-based clinical communication evaluation is a requirement for children with speech-language impairments living in rural areas, and those who have limited mobility. AIMS: To determine the validity and reliability of the Turkish version of the Viking Speech Scale (VSS-T) via live and video-based observation for children with cerebral palsy (CP) aged 4-18 years. METHODS & PROCEDURES: A total of 142 children (mean age 8.18 ± 3.98 years; 68 female) with CP were included in this study. Their motor, communication, visual and eating-drinking function levels and comorbidities (dental, swallowing, cognitive impairments and epilepsy) were recorded. The Intelligibility in Context Scale (ICS), the Pediatric Evaluation of Disability Inventory-Social Function (PEDI-SF), and the Functional Independence Measure for Children-Communication (WeeFIM-C) were assessed to examine the concurrent validity of the VSS-T. The interrater reliability of the VSS-T was analysed between parents, physical therapists, and speech and language therapists from live and video-based observation. Intra-rater reliability was calculated from ratings made from live and video-based observations taken 3 weeks apart. OUTCOMES & RESULTS: The VSS-T was strongly related to the ICS (r = -0.830), PEDI-SF (r = -0.819), WeeFIM-C (r = -0.643), other functional classifications (r > 0.432), and the comorbidities (Cramer's V > 0.284, p < 0.001). Good to excellent interrater reliability (κw ≥ 0.838) and intra-rater reliability (intraclass correlation coefficient (ICC) = 0.848-0.995) were found between parents and therapists. CONCLUSIONS & IMPLICATIONS: Speech and language therapists, physical therapists, and parents can use the VSS-T as a valid and reliable classification system to describe speech intelligibility of 4-18-year-old children with CP. Both live and video-based observations can be used to administer the VSS-T. WHAT THIS PAPER ADDS: What is already known on the subject The English version of the VSS has been shown to be a valid and reliable tool used to classify the speech of children with CP aged 4-13 years. The scale can be administered by means of live observation of the child or based on clinicians' notes on the case by parents, SLTs, physiotherapists and paediatricians. What this paper adds to existing knowledge The VSS-T is valid and reliable for children with CP aged 4-18 years. Video-based observation is a suitable method for evaluating the VSS-T levels. The VSS-T has a moderate association with the CFCS. What are the potential or actual clinical implications of this work? The VSS-T is a valid and reliable method of categorizing the severity of motor speech impairment for Turkish children with CP in clinical research studies, registry systems or epidemiological studies. Both experienced and inexperienced therapists can use either live or video-based observation methods to administer the VSS-T. This study extended the validity and reliability of the scale in children with CP aged up to 18 years. The VSS-T is also associated with the Visual Functional Classification System (VFCS), which has been recently developed for describing the visual abilities of children with CP in daily life. In addition, the VSS-T is associated with the presence of dental, swallowing, cognitive problems and epilepsy.

Clinical evaluation of muscle functions in neurofibromatosis type 1.

AIM: Muscle weakness, fatigue and speech problems can occur in neurofibromatosis type 1 (NF1). The pathogenesis of these symptoms is unclear, likely multifactorial. We examined motor function in limb and speech muscles in NF1 patients. METHODS: We evaluated NF1 and control groups aged 4-18 years for muscle strength, tone and mobility using standard manual testing, joint motion and Beighton score measurements. Speech and language functions were assessed by speech articulation and resonance. As a marker of muscle tissue turnover, we determined collagen degradation products in urine before and after submaximal exercise. RESULTS: NF1 patients had reduced strength in proximal limb muscles compared to control subjects. Speech articulation problems and hypernasality were more common in NF1 (47% and 38%, respectively). Collagen products excreted in urine correlated with gluteal and biceps muscle strength. CONCLUSION: Muscle dysfunction can be detected in some children with NF1 and may explain certain clinical features including fatigue, speech and articulation problems. If confirmed by further research, these findings may be relevant to the management of this condition.

Investigation of the Effect of Radiotherapy Dose on Chewing and Swallowing Structures in Head and Neck Cancer Patients Treated with Concomitant Chemoradiotherapy.

Intensity-modulated radiotherapy (IMRT) is a treatment method that is used in the treatment of head and neck cancers. Impairment of chewing and swallowing functions in the early and late periods of radiotherapy is frequent. Therefore, revealing the dose-effect relationship is important. The main purpose of this study is to investigate the dose-effect relationship between chewing and swallowing structures objectively via a standardized videofluoroscopy protocol. The study included 35 participants treated with chemo-IMRT. A videofluoroscopic swallowing study (VFSS) was performed before IMRT, and 3 and 6 months after IMRT. VFSS results were scored according to the Modified Barium Swallow Impairment Profile (MBSImP) and the Penetration-Aspiration Scale (PAS). Maximum interincisor mouth opening, body mass index (BMI), and Functional Oral Intake Scale levels were determined in these cases. The quality of life of participants was evaluated. There was a significant increase in PAS and MBSImP scores and a significant decrease in BMI scores of the patients after treatment. Xerotomy and sticky saliva complaints increased after treatment. The dose to the mastication muscles (> 40 Gy) and the temporomandibular joint (> 46 Gy) were found to be associated with a decrease in BMI; the dose to the superior pharyngeal constructor muscle (> 58 Gy) was found to be associated with pharyngeal stripping wave. The presence of aspiration was associated with the inferior pharyngeal constructor muscle, glottic larynx, supraglottic larynx, and upper esophageal sphincter. Important findings to emerge from this study include detected toxic dose limits. These findings may guide physicians to minimize the side effects of IMRT.

Investigating Validity and Reliability of the Turkish Version of Transsexual Voice Questionnaire (Male to Female).

OBJECTIVE: The problems faced by trans women with regard to their voice may affect their quality of life. For the evaluation of trans women's voice, tools assessing their self-perception are very important, with the Transsexual Voice Questionnaire (TVQMtF ) being one of the most frequently used. The purpose of this study was to investigate the validity and reliability of the Turkish version of the TVQMtF (TVQMtF -TR), which was previously translated into 12 languages. STUDY DESIGN: Cross-sectional study. METHOD: A total of 41 trans women participated in this study. The participants filled out the TVQMtF -TR, the self-perceptions of voice femininity questionnaire, and the World Health Organization Quality of Life Questionnaire-Short Form (WHOQOL-BREF-TR). Additionally, 58.5% of the participants filled out the TVQMtF -TR again two weeks after the first interview. RESULTS: The total Cronbach's-α value of the TVQMtF -TR was 0.972, and the item-total correlation values were found to be between 0.323 and 0.876. The intraclass correlation coefficient value was 0.931. There was a strong negative correlation between TVQMtF -TR and self-perceptions of voice femininity. There was a significant negative correlation between TVQMtF -TR and the psychological and environmental domains of WHOQOL-BREF-TR. However, there was no significant relationship found between the social and physical domains. CONCLUSION: According to the results of the study, the Turkish version of TVQMtF -TR was considered a valid and reliable tool.

The Effects of Age and Gender on Laryngeal Aerodynamics in the Children Population.

OBJECTIVES: Normal voice can be differentiated from dysphonic voices by comparing their characteristics using an established normative database. Pediatric normative data using the Phonatory Aerodynamic System (PAS) have been established in a preliminary study for English-speaking children. However, aerodynamic measures, including physical characteristics varying by geographic region, race, and culture, must be investigated between children with different native languages. Aerodynamic analysis of connected speech requires the collection of language-specific samples and the establishment of language-specific norms. Thus, the main purpose of the present study was to establish pediatric normative data using the PAS for a large pediatric population of healthy Turkish-speaking children of 4-17.11 years of age. Another research aim was to determine age-dependent and/or gender-dependent aerodynamic parameters for this pediatric population. METHODS: In total, 120 children were divided into four age groups: Group I, 4-5.11 years; Group II, 6-9.11 years; Group III, 10-13.11 years; and Group IV, 14-17.11 years. An equal number of male and female participants were assigned to each group. The PENTAX Medical PAS Model 6600 was used. Descriptive statistics for 56 parameters across six protocols were expressed as mean, standard deviation, and range values. Each protocol was analyzed for age, gender, and age-gender interaction. RESULTS: Age was the most predominant factor, affecting 37 of the 56 aerodynamic parameters investigated. Gender and age-gender factors were observed at an equal frequency, each affecting 16 parameters. Pitch-related parameters were the most altered parameters in each protocol. Age-gender interaction was observed in parameters related to the expiratory airflow. CONCLUSIONS: This study established the normative values of phonatoary aerodynamics for a large pediatric population with a wide age range and developed a normative database for healthy Turkish-speaking children. This is the first study to investigate running speech protocol in aerodynamic assessment.

Validity and Reliability of the Turkish SingingVoice Handicap Index-10.

OBJECTIVE: To evaluate the validity and reliability of the Turkish version of the Singing Voice Handicap Index-10 (SVHI-10). STUDY DESIGN: Cross-sectional study. METHODS: Two hundred singers consisting of a control group (n = 136) without voice complaints and a study group (n = 64) diagnosed with a voice disorder served as participants. To detect test-retest reliability, 97 participants (representing a portion of both the control and study group participants) completed the index twice with a minimum of a one-week interval between each completion. Internal consistency was confirmed using Cronbach's alpha coefficient. To complete a clinical validity assessment, scores from the control group participants were compared with scores from the study group participants. To determine content validity, the correlation between the SVHI-10 and the participants' perceptions of singing voice complaints was researched. The sensitivity and specificity of the SVHI-10/Turkish version were calculated using a receiver operating characteristic curve analysis. RESULTS: Cronbach's alpha coefficient, which was equal to 0.91, proved to have excellent internal consistency. Item-total correlations were found in the range of 0.55 to 0.76. The mean SVHI-10/Turkish score for the control group was 8.14 ± 5.4, whereas this value was significantly higher in the study group (20.54 ± 6.9, P < 0.001). The Pearson product-moment correlation test indicated that the Turkish SVHI-10 is a reliable tool (r = 0.90, n = 97, P < 0.001). The area under curve of the Turkish SVHI-10 was 0.95. The optimal cut-off point was found to be 11.5, with a sensitivity of 95.8% and a specificity of 83.2%. CONCLUSIONS: The Turkish version of the SVHI-10 has proven to be a reliable and valid instrument for evaluating the self-perception of a singer in relation to voice problems. It can also be used as a quick screening tool because a score on the SVHI-10 higher than 11.5 is indicative of an abnormal singer's perceived voice handicap.

Use of cepstral analysis for differentiating dysphonic from normal voices in children.

OBJECTIVES: Cepstral measures have mainly been evaluated by studies conducted on dysphonic and healthy adults, and many of these studies have reported the advantages of using cepstral measures for the evaluation of dysphonia however there is a paucity regarding to the cepstral analyses' results in dysphonic children. In this present study, it is hypothesized that cepstral peak prominence (CPP) and some other parameters of cepstral analysis would differ in children with vocal nodules when compared with the same parameters of cepstral analysis of healthy children. METHODS: In this present study, totally 54 children aged between 5 years old to 12 years and 7 months participated. The study group consisted of 20 males and 7 females diagnosed with vocal nodules. The control group consisted of an equal number of age- and gender-matched healthy peers. Analysis of Dysphonia in Speech and Voice software (CSL Model 4500 equipment, Kay Elemetrics Group) was used to gather speech sample recordings according to the Consensus Auditory-Perceptual Evaluation of Voice/Turkish protocol. Cepstral measures of all the six CAPE-V sentences and sustained/a/sample were calculated. CPP, CPP fundamental frequency, CPP standard deviation (CPP SD), Low_high spectral ratio (L/H ratio), L/H ratio standard deviation parameters were taken into account when statistical analyses were completed. In addition to the descriptive statistics of ceptral measures for both groups, the differences between the study and control groups according to the gender were documented. RESULTS: It was found that for both genders CPP and CPP SD values were significantly higher for the control group for vowel-weighted sample, all voiced-weighted sample, glottal attack-weighted sample, nasal weighted sample, and voiceless-weighted sample. In the vowel-weighted sample, CPP and CPP SD were significantly higher for the control group in males. In females, a difference was only observed on the CPP parameter for the same sentence. In terms of the CPP value of the sustained phonation sample, a significant difference was only detected for males, whereas no difference was detected for females. CONCLUSIONS: In conclusion, present study found that cepstral analysis can be used to determine the difference between dysphonic and healthy voices of children and indicated that cepstral analysis should be a compulsory component of routine clinical voice evaluation of children. In addition, this present study indicates that of the cepstral analysis of sentences appear to be more sensitive to dysphonia than the analysis of vowel samples. In future studies, normative values of the CAPE-V/Turkish sentences and cutoff values for differentiating dysphonia from normal voice should be evaluated using a larger sample size.

Turkish Standardized Reading Passage for the Evaluation of Hard Glottal Attack Occurrence Frequency.

OBJECTIVE: This study aimed to develop a Turkish reading passage that can be used in evaluating the frequency of hard glottal attack (HGA) and to assess its reliability. STUDY DESIGN: This is a prospective case-control study. METHODS: The Towne-Heuer reading passage is a valuable tool that can be used for the auditory-perceptual assessment of voice. The characteristics of the first four paragraphs of the reading passage were analyzed by a linguist. Then, a Turkish reading passage with similar characteristics was developed. The control group (n = 21) consisted of individuals with no voice disorder. The study group consisted of two subgroups that were diagnosed as having vocal fold nodules (n = 11) and muscle tension dysphonia (n = 10). A total of three listeners were evaluated for the frequency of HGAs. One of the listeners was a master's student, whereas the other two listeners were speech-language pathologists. Consistency between the listeners was evaluated by using the percent agreement and the kappa statistics. Intrarater reliability was assessed by the Wilcoxon sign test. The t test was used to evaluate potential differences between the groups. The results were considered as significant if the P value was <0.05. RESULTS: The average attack number in the study group was found to be significantly higher than the controls (P < 0.05). No significant difference could be discerned between the muscle tension dysphonia and vocal nodule subgroups (P > 0.05). CONCLUSIONS: Findings confirmed that HGAs are clearly related to the vocal hyperfunction; however, the mechanism of action needs more research. In addition, the relationship between syllable stress and HGA should be further researched to clarify the cause of the attack number differences between English and Turkish languages.

Investigation of the speech results of posterior pharyngeal wall augmentation with fat grafting for treatment of velopharyngeal insufficiency.

PURPOSE: The purpose of this study was to evaluate the speech results of posterior pharyngeal wall augmentation (PPWA) with fat grafting both in the early and late postoperative period, and to clarify the impact of the procedure concomitant with speech therapy. MATERIALS AND METHODS: This is a prospective case-control study. The study involved 87 cleft palate ± cleft lip patients with velopharyngeal insufficiency (VPI) who has been treated with PPWA. Patients were separated into two groups according to age; the first group consisted of 49 pediatric participants between 6 and 12 years of age and the second group consisted of 38 adolescent participants between 13 and 18 years of age. Preoperative velopharyngeal function and articulation were compared postoperatively at the following time points: the 3rd month, 12th month, 18th month and 24th month. The velopharyngeal function was evaluated with regards to the velopharyngeal closure type and velopharyngeal closure amount, by using the pediatric flexible nasoendoscopy and the nasometer methods. In the nasometer evaluation, nasalance sores were measured by using nonsense syllables and meaningful sentences. The Ankara Articulation Test (AAT) (Ege et al., 2004) was used to detect compensatory articulation products secondary to VPI. Consonant production error types and frequencies were determined according the guidelines stated in the study of Hardin-Jones et al. (2009). These were Pharyngeal Fricatives - Posterior Nasal Fricatives/Stop Production, Glottal Stop Production, Middorsum Palatal Stop Production, Nasal Frictional Production, Posterior Nasal Frictional Production/Phoneme Specific Nasal Emission, use of Nasal Consonants for Oral Consonants, and Replacement of Trills. All the participants received concurrent speech therapy four times, twice in the post-operative period between 1 and 3 months and twice between 3 and 6 months. RESULTS: PPWA improved the speech performance from the 18th month to 24th month of the postoperative period. AAT assessment of the first group after 24 months comparing the post-PPWA with the preoperative data showed a highly significant decrease with regard to compensatory production errors and hypernasality; however, in the second group, the same comparison revealed a highly significant decrease in regard to the degree of hypernasality and a significant difference in terms of glottal articulation and pharyngealization of fricatives. A circular closure pattern was observed in 17 individuals with cleft palate at a rate of 70.6%. CONCLUSION: PPWA with concurrent speech therapy is an acceptable surgical method to correct VPI and to improve speech performance.

Comparing the effects of Essix and Hawley retainers on the acoustics of speech.

OBJECTIVE: The aim of this study was to compare the effects of two retainer types (Essix and Hawley) on speech performance. SUBJECTS AND METHODS: The speech articulation of 30 patients was evaluated prospectively. Five patients did not appear during the follow-up periods. The patients were randomly divided into retention groups by treatment allocation cards as Essix and Hawley. The Essix group included 13 participants with a mean age of 15.3±2.4 years; the Hawley group included 12 participants with a mean age of 16.3±2.56 years. Speech sound assessments were performed on the first day and 1 week, 4 weeks, and 3 months later. On the first day, the assessments were conducted prior to inserting the retainers, immediately after maxillary and mandibular retainer application, individually, and with both retainers applied. The acoustic analyses were obtained using spectral and temporal parameters. RESULTS: Statistical analyses were performed with IBM SPSS for Windows, version 20. A P value less than 0.05 was considered statistically significant. The most apparent changes were found in the [a] vowel in the Hawley group, the [e] vowel in the Essix group, and the [u] vowel in both groups (P < 0.05). While the number of affected consonant-vowel couples in the Essix group was low, alterations were common in the Hawley group. There was a statistically significant difference (P < 0.05) in voice onset time of the [d] sound between the groups. LIMITATIONS: The trial had a small sample size and a short follow-up period. CONCLUSIONS: The Hawley retainer affected articulatory movements in consonant-vowel combinations more prominently than the Essix retainer did. Voice onset time of the consonant [d] in the Hawley group was shorter than normal, indicating rapid articulatory movement in the alveolar region.