The Design and Assessment of a Multiparametric Model for the Dysphonia Severity Index for Persian-speaking Populations.

OBJECTIVES: In instrumental voice assessment, multiparametric models reflect the multidimensional nature of voice and are therefore better than models that reflect only a single dimension of voice. The Dysphonia Severity Index (DSI) is one of the most common multiparametric models. In voice assessment, race, language, and structural and physiological features affect the acoustic, aerodynamic, and voice range profile measures. Given these differences, this study was conducted to design and evaluate a multiparametric and objective model for assessing the severity of dysphonia in Persian-speaking populations. MATERIAL AND METHODS: This study examined 300 participants with several types of dysphonia (104 women and 196 men) and 100 healthy individuals (63 women and 37 men). Five acoustic parameters, three aerodynamic parameters, and seven voice range profile parameters were measured for designing the model. Perceptual evaluation was performed using the grade, roughness, breathiness, asthenia, strain scale. The logistic regression analysis was used to determine the factors affecting the DSI and each component's coefficient. RESULTS: Of the 15 parameters assessed, shimmer, vital capacity, semitone range, and voice onset time of /pa/ remained in the model with their coefficients. This section presents the DSI model for the examined population. The discriminant analysis showed that this combination corresponds to 47.8 of the perceptual assessment: DSI = 0.289 (shimmer) + 0.0001 (VC) - 0.059 (STR) - 13.278 (VOT_Pa). CONCLUSION: In this study, the DSI corresponded to the physiological, linguistic, and racial characteristics of the Persian-speaking population with or without voice disorder.

The Mandarin Version of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) and Its Reliability.

Purpose: The purpose of this study is to develop the Mandarin version of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) and evaluate its reliability compared with the Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS). Method: The Mandarin version of the CAPE-V tool was translated from the validated English version with phonemic adaptations, content adjustment, and scale modification. Sixty dysphonic, 20 normal, and 20 repeated voice samples were included in this study. Ten of these were used for preassessment training; the remaining 90 were evaluated using the Mandarin CAPE-V and GRBAS for comparison of their interrater and intrarater reliabilities. Results: Intrarater reliability was measured by Pearson r for the CAPE-V and Spearman rho for the GRBAS. Average CAPE-V Pearson r ranged from 0.80 for strain to 0.91 for overall severity, compared with average GRBAS Spearman rho of 0.83 for strain to 0.89 for asthenia. Interrater reliability was measured by an intraclass coefficient (ICC). Average CAPE-V ICCs ranged from .57 for pitch to .81 for overall severity, compared with average GRBAS ICCs of .60 for asthenia to .83 for grade. Conclusions: The Mandarin CAPE-V addresses some limits of the English version. It also demonstrates good intrarater and interrater reliability, comparable to those of GRBAS.

Socioeconomic Variables of Patients with Spasmodic Dysphonia: A Preliminary Study.

OBJECTIVES/HYPOTHESIS: To characterize socioeconomic status (SES) variables of spasmodic dysphonia (SD) patients and determine their impact on voice outcomes after treatment with botulinum toxin. STUDY DESIGN: Retrospective review. MATERIALS AND METHODS: SD patients treated with botulinum toxin for the past 10 years (July 2007-July 2017) for whom sufficient SES and outcome data were available were included. Spearman rho nonparametric correlation coefficients were calculated to determine if SES variables were significantly associated with self-perceived vocal quality. Voice Handicap Index-10 was recorded. Patients were asked at each visit to rate their best voice quality during the period of previous botulinum toxin injection on a scale of 1-10, with 10 being the best. RESULTS: Fifty SD patients were included. Average age was 60.3 ± 11.4 years, with men representing 24% of patients. Ethnicity was 74% Caucasian and 26% non-Caucasian. Median household income was $76,564 ± $24,782. Sixty-six percent of patients were employed. Adductor SD was diagnosed in 82% of patients and abductor SD in 12%. Best voice out of 10 was 7.23 ± 2.0. Mean Voice Handicap Index-10 score was 25.14 ± 9.4. Patients were treated with botulinum toxin for 165.9 ± 101.9 months. Age, gender, median household income, ethnicity, and employment status were not significantly associated with self-perceived vocal quality. Patients with longer disease duration self-reported a better voice (P = 0.02, r = 0.387). CONCLUSIONS: SES variables were not associated with voice outcomes for SD patients treated with botulinum toxin. Patients self-reported improved voice with longer duration of disease.

Effect of geographical and ethnic variation on Dysphonia Severity Index: a study of Indian population.

Dysphonia Severity Index (DSI) is a widely used multiparametric approach to objectively quantify the voice quality. Few research groups have investigated the test-retest, interobserver variability, and influence of age and gender. They have also verified the application of DSI in various voice rehabilitation conditions. However, all these studies have been conducted on European population. There is a possibility of variation in the basic parameters of DSI across geographical and ethnic groups. Hence, the present study evaluated DSI in Indian population. One hundred twenty voluntary participants (60 males, 60 females) who had G(0) on the Grade, Roughness, Breathiness, Aesthenia, Strain (GRBAS) scale participated in the study (age range of 18-25 years, M=21.8, standard deviation=2.7). Maximum phonation time (MPT), frequency intensity, and jitter measurements were made using CSL 4500 (Kay Elemetrics, Pine Brook, NJ). Results showed noticeable difference between Indian and European population on MPT, Highest frequency (F(0)-High), and DSI values. Significant gender difference was also observed on MPT and F(0)-High. Test-retest reliability showed >95% for all the parameters. The MPT decrement lead to a reduction in the overall DSI value in both the genders. These results of the study caution voice professionals to reinvestigate and establish their own norms for their geographical and ethnic groups.

Possible cross-cultural differences in the perception of impact of voice disorders.

UNLABELLED: Perception of the impact of voice disorders may differ across different cultural backgrounds. This study investigated the difference in the perception of the impact of voice disorders between the American (Pittsburgh) and Chinese (Hong Kong) cultures. STUDY DESIGN AND SETTING: Sixty dysphonic subjects from Hong Kong, China, and 60 dysphonic subjects from Pittsburgh, USA, were recruited to complete the Chinese and English versions of the Voice Activity and Participation Profile (VAPP), respectively. Data analyses using independent t tests were conducted on (1) the total profile scores; (b) total activity limitation score (ALS) and total participation restriction score (PRS); (c) section scores of job, daily communication, and social communication; and (d) section ALS and section PRS. RESULTS: Hong Kong subjects showed significantly higher scores than the Pittsburgh subjects in total profile and other subsections except in the job PRS. CONCLUSION: RESULTS support the possible influence of individualist and collectivist cultures on the perceived impact of voice disorders on the activity and participation.

Application of the Mandarin Chinese version of the Voice Handicap Index.

OBJECTIVES: To investigate the characteristics and clinical application of Mandarin Chinese version of the Voice Handicap Index (VHI). METHODS: A cross-culture adaptation was used to develop the Mandarin Chinese version of the VHI. The translated version was then administered to 1766 dysphonic patients and 120 control subjects; 210 of the patients were treated with phonosurgery or BOTOX injection. Disorders were chronic laryngitis, benign vocal fold disorders, pathologic sulcus vocalis, benign or malignant tumors of vocal fold, spasmodic dysphonia (SD) and unilateral vocal fold paralysis (UVFP), and functional dysphonia. RESULTS: The Cronbach's α score for the overall VHI was 0.956; the functional, physical, and emotional subscales had values of 0.922, 0.872, and 0.933, respectively. The test-retest reliability coefficient was 0.991 (P<0.01). Correlations between the subscales and the overall VHI as well as among the subscales were all significant (P<0.01) Principal-component analysis revealed six-factor eigenvalues exceeding 1, explaining 75.39% of the total variance. The total VHI scores and subscale scores were statistically higher for dysphonic groups (P<0.001). The order of disease classification from highest score to lowest score was: SD, functional dysphonia, UVFP, sulcus vocalis, benign and malignant tumor, benign vocal fold disorders, and chronic laryngitis. The emotional scores were the highest in SD, and followed by functional dysphonia; the physical scores were the highest in the other groups. Treatment leads to statistically improvement in VHI scores (P<0.05). CONCLUSION: The Mandarin Chinese version of VHI appears to be a reliable and valid tool in assessing dysphonia in Mandarin Chinese speakers.