Discussions on Auditory-Perceptual Evaluation Performed in Patients With Voice Disorders

The auditory-perceptual evaluation of speech-language pathologists (SLP) in patients with voice disorders is often regarded as a touchstone in the multi-dimensional voice evaluation procedures and provides important information not available in other assessment modalities. Therefore, it is necessary for the SLPs to conduct a comprehensive and in-depth evaluation of not only voice but also the overall speech production mechanism, and they often encounter various difficulties in the evaluation process. In addition, SLPs should strive to avoid bias during the evaluation process and to maintain a wide and constant spectrum of severity for each parameter of voice quality. Lastly, it is very important for the SLPs to perform a team approach by documenting and delivering important information pertaining to auditory-perceptual characteristics in an appropriate and efficient way through close communication with the laryngologists.

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Determining Medical Urgency of Voice Disorders Using Auditory-Perceptual Voice Assessments Performed by Speech-Language Pathologists

Annals of Otology Rhinology & Laryngology ◽

10.1177/00034894211032779 ◽

2021 ◽

pp. 000348942110327

Author(s):

Robert Brinton Fujiki ◽

Peter W. Sanders ◽

M. Preeti Sivasankar ◽

Stacey Halum

Keyword(s):

Medical History ◽

Laryngeal Cancer ◽

Patient Information ◽

Voice Quality ◽

Voice Disorders ◽

Smoking History ◽

Voice Disorder ◽

Speech Language Pathologists ◽

Laryngeal Paralysis ◽

History Information

Objective: This study examined whether speech-language pathologist auditory-perceptual voice assessments can predict the medical urgency of voice disorders. Methods: Twenty speech-language pathologists (SLPs) evaluated 25 voice samples recorded during initial voice evaluations. Voice samples represented a range of dysphonia severity (mild-severe) balanced across patient diagnoses. Diagnoses included: benign lesions, laryngeal cancer, non-organic voice disorders, laryngeal edema (associated with LPR), and laryngeal paralysis or paresis. Laryngeal cancer and severe unilateral laryngeal paralysis were considered urgent disorders. While blinded to patient information, SLPs rated severity of voice quality, predicted patient diagnosis, and determined whether the patient should be seen urgently by a laryngologist. SLPs were then given basic medical history information and rated medical urgency of voice disorder a second time. Results: On average, SLPs correctly identified 65% of urgent voices and 87% of nonurgent voices when blinded to patient information. Accuracy improved significantly to 86% for urgent voices with medical history information ( P < .001) and decreased to 77% for nonurgent voices. Accuracy was better when severity of voice quality was severe for urgent voices and mild for nonurgent voices ( P < .001). SLPs indicated that patient smoking history and severity of dysphonia were most influential in their decision making. Diagnostic accuracy of auditory-perceptual assessments was poor. Conclusions: SLPs identified 86% of medically urgent voice disorders when auditory perceptual assessments were combined with medical history information. Further work is needed to determine what medical history information is most crucial to rating accuracy and what speech tasks might best separate urgent and nonurgent patients.

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Effect of Teacher Training Sessions on Listener Perception of Voice Disorders

Language Speech and Hearing Services in Schools ◽

10.1044/0161-1461.1601.25 ◽

1985 ◽

Vol 16 (1) ◽

pp. 25-28 ◽

Cited By ~ 5

Author(s):

Nicholas J. DeGregorio ◽

Nancy Gross Polow

Keyword(s):

Teacher Training ◽

School System ◽

Voice Disorders ◽

Future Research ◽

Speech Language Pathologists ◽

Speech Language Pathologist ◽

Bergen County ◽

Experimental Group

The present study was designed to investigate the effect of teacher training sessions on listener perception of voice disorders. Three ASHA certified speech-language pathologists provided the criteria mean. Thirty randomly selected teachers from a Bergen County school system, randomly placed into two groups, served as subjects. The experimental group received three training sessions on consecutive weeks. Three weeks after the end of training, both groups were given a posttest. Listener perception scores were significantly higher for the experimental group. The implications of these results for in-service workshops, teacher/speech-language pathologist interaction and future research are discussed.

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Cultural and Linguistic Adaptation of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) Into Hindi

Journal of Speech Language and Hearing Research ◽

10.1044/2020_jslhr-20-00348 ◽

2020 ◽

Vol 63 (12) ◽

pp. 3974-3981

Author(s):

Ashwini Joshi ◽

Isha Baheti ◽

Vrushali Angadi

Keyword(s):

Strong Correlation ◽

Concurrent Validity ◽

Interrater Reliability ◽

Voice Quality ◽

Weak Correlation ◽

Voice Assessment ◽

Perceptual Evaluation ◽

Severity Grade ◽

Normal Voice ◽

Group A

Aim The purpose of this study was to develop and assess the reliability of a Hindi version of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V). Reliability was assessed by comparing Hindi CAPE-V ratings with English CAPE-V ratings and by the Grade, Roughness, Breathiness, Asthenia and Strain (GRBAS) scale. Method Hindi sentences were created to match the phonemic load of the corresponding English CAPE-V sentences. The Hindi sentences were adapted for linguistic content. The original English and adapted Hindi CAPE-V and GRBAS were completed for 33 bilingual individuals with normal voice quality. Additionally, the Hindi CAPE-V and GRBAS were completed for 13 Hindi speakers with disordered voice quality. The agreement of CAPE-V ratings was assessed between language versions, GRBAS ratings, and two rater pairs (three raters in total). Pearson product–moment correlation was completed for all comparisons. Results A strong correlation ( r > .8, p < .01) was found between the Hindi CAPE-V scores and the English CAPE-V scores for most variables in normal voice participants. A weak correlation was found for the variable of strain ( r < .2, p = .400) in the normative group. A strong correlation ( r > .6, p < .01) was found between the overall severity/grade, roughness, and breathiness scores in the GRBAS scale and the CAPE-V scale in normal and disordered voice samples. Significant interrater reliability ( r > .75) was present in overall severity and breathiness. Conclusions The Hindi version of the CAPE-V demonstrates good interrater reliability and concurrent validity with the English CAPE-V and the GRBAS. The Hindi CAPE-V can be used for the auditory-perceptual voice assessment of Hindi speakers.

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Pediatric Benign Vocal Fold Lesions: A Team Approach

Perspectives on Voice and Voice Disorders ◽

10.1044/vvd19.3.105 ◽

2009 ◽

Vol 19 (3) ◽

pp. 105-112 ◽

Cited By ~ 3

Author(s):

Geralyn Harvey Woodnorth ◽

Roger C. Nuss

Keyword(s):

Vocal Fold ◽

Evaluation Process ◽

Team Approach ◽

Speech Language Pathologist ◽

Benign Vocal Fold Lesions ◽

Different Types ◽

Team Evaluation ◽

Surgical Treatments ◽

Review Current ◽

Vocal Fold Nodules

Abstract Many children with dysphonia present with benign vocal fold lesions, including bilateral vocal fold nodules, cysts, vocal fold varices, and scarring. Evaluation and treatment of these children are best undertaken in a thoughtful and coordinated manner involving both the speech-language pathologist and the otolaryngologist. The goals of this article are (a) to describe the team evaluation process based on a “whole system” approach; (b) to discuss etiological factors and diagnosis; and (c) to review current medical, behavioral, and surgical treatments for children with different types of dysphonia.

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What Have We Learned From Physiological Approaches to Characterizing Dysarthria and Other Speech Production Disorders?

Perspectives on Speech Science and Orofacial Disorders ◽

10.1044/ssod20.2.37 ◽

2010 ◽

Vol 20 (2) ◽

pp. 37-46

Author(s):

Nicole M. Etter

Keyword(s):

Speech Production ◽

Speech Disorders ◽

Research Literature ◽

Systematic Research ◽

Physiological Measures ◽

Validity And Reliability ◽

Assessment Measures ◽

Perceptual Assessment ◽

Perceptual Characteristics ◽

Diagnostic Resolution

Traditionally, speech-language pathologists (SLP) have been trained to develop interventions based on a select number of perceptual characteristics of speech without or through minimal use of objective instrumental and physiologic assessment measures of the underlying articulatory subsystems. While indirect physiological assumptions can be made from perceptual assessment measures, the validity and reliability of those assumptions are tenuous at best. Considering that neurological damage will result in various degrees of aberrant speech physiology, the need for physiologic assessments appears highly warranted. In this context, do existing physiological measures found in the research literature have sufficient diagnostic resolution to provide distinct and differential data within and between etiological classifications of speech disorders and versus healthy controls? The goals of this paper are (a) to describe various physiological and movement-related techniques available to objectively study various dysarthrias and speech production disorders and (b) to develop an appreciation for the need for increased systematic research to better define physiologic features of dysarthria and speech production disorders and their relation to know perceptual characteristics.

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Measuring Vocal Fatigue in Sports Coaches

Journal of Clinical Speech and Language Studies ◽

10.3233/acs-2017-23104 ◽

2017 ◽

Vol 23 (1) ◽

pp. 1-20

Author(s):

Kathy Connaughton ◽

Irena Yanushevskaya

Keyword(s):

Acoustic Analysis ◽

Voice Quality ◽

Professional Sports ◽

Muscle Adaptation ◽

Voice Change ◽

Acoustic Measures ◽

Perceptual Evaluation ◽

Coaching Session ◽

Sports Coaches ◽

Voice Use

Objective: This study explores the immediate impact of prolonged voice use by professional sports coaches. Method: Speech samples including sustained phonation of vowel /a/ and a short read passage were collected from two professional sports coaches. The audio recordings were made within an hour before and after a coaching session, over three sessions. Perceptual evaluation of voice quality was done using the GRBAS scale. The speech samples were subsequently analyzed using Praat. The acoustic measures included fundamental frequency (f0), jitter, shimmer, Harmonics-to-Noise ratio and Cepstral Peak Prominence. Main results: The results of perceptual and acoustic analysis suggest a slight shift towards a tenser phonation post-coaching session, which is a likely consequence of laryngeal muscle adaptation to prolonged voice use. This tendency was similar in sustained vowels and connected speech. Conclusion: Acoustic measures used in this study can be useful to capture the voice change post-coaching session. It is desirable, however, that more sophisticated and robust and at the same time intuitive and easy-to-use tools for voice assessment and monitoring be made available to clinicians and professional voice users.

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A Randomized Controlled Trial of Two Semi-Occluded Vocal Tract Voice Therapy Protocols

Journal of Speech Language and Hearing Research ◽

10.1044/2015_jslhr-s-13-0231 ◽

2015 ◽

Vol 58 (3) ◽

pp. 535-549 ◽

Cited By ~ 55

Author(s):

Mara R. Kapsner-Smith ◽

Eric J. Hunter ◽

Kimberly Kirkham ◽

Karin Cox ◽

Ingo R. Titze

Keyword(s):

Quality Of Life ◽

Vocal Tract ◽

Controlled Trial ◽

Voice Quality ◽

Voice Handicap Index ◽

Voice Therapy ◽

Control Group ◽

Perceptual Evaluation ◽

Therapy Program

PurposeAlthough there is a long history of use of semi-occluded vocal tract gestures in voice therapy, including phonation through thin tubes or straws, the efficacy of phonation through tubes has not been established. This study compares results from a therapy program on the basis of phonation through a flow-resistant tube (FRT) with Vocal Function Exercises (VFE), an established set of exercises that utilize oral semi-occlusions.MethodTwenty subjects (16 women, 4 men) with dysphonia and/or vocal fatigue were randomly assigned to 1 of 4 treatment conditions: (a) immediate FRT therapy, (b) immediate VFE therapy, (c) delayed FRT therapy, or (d) delayed VFE therapy. Subjects receiving delayed therapy served as a no-treatment control group.ResultsVoice Handicap Index (Jacobson et al., 1997) scores showed significant improvement for both treatment groups relative to the no-treatment group. Comparison of the effect sizes suggests FRT therapy is noninferior to VFE in terms of reduction in Voice Handicap Index scores. Significant reductions in Roughness on the Consensus Auditory-Perceptual Evaluation of Voice (Kempster, Gerratt, Verdolini Abbott, Barkmeier-Kraemer, & Hillman, 2009) were found for the FRT subjects, with no other significant voice quality findings.ConclusionsVFE and FRT therapy may improve voice quality of life in some individuals with dysphonia. FRT therapy was noninferior to VFE in improving voice quality of life in this study.

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Differences in Children’s Sound Production When Speaking With a Cochlear Implant Turned On and Turned Off

Journal of Speech Language and Hearing Research ◽

10.1044/jshr.3903.604 ◽

1996 ◽

Vol 39 (3) ◽

pp. 604-610 ◽

Cited By ~ 16

Author(s):

Nancy Tye-Murray ◽

Linda Spencer ◽

Elizabeth Gilbert Bedia ◽

George Woodworth

Keyword(s):

Cochlear Implant ◽

Speech Production ◽

Cochlear Implants ◽

Sound Production ◽

Proprioceptive Feedback ◽

Speech Sample ◽

Speech Language Pathologists ◽

Monosyllabic Words ◽

Consonant Voicing ◽

Vowel Height

Twenty children who have worn a Cochlear Corporation cochlear implant for an average of 33.6 months participated in a device-on/off experiment. They spoke 14 monosyllabic words three times each after having not worn their cochlear implant speech processors for several hours. They then spoke the same speech sample again with their cochlear implants turned on. The utterances were phonetically transcribed by speech-language pathologists. On average, no difference between speaking conditions on indices of vowel height, vowel place, initial consonant place, initial consonant voicing, or final consonant voicing was found. Comparisons based on a narrow transcription of the speech samples revealed no difference between the two speaking conditions. Children who were more intelligible were no more likely to show a degradation in their speech production in the device-off condition than children who were less intelligible. In the device-on condition, children sometimes nasalized their vowels and inappropriately aspirated their consonants. Their tendency to nasalize vowels and aspirate initial consonants might reflect an attempt to increase proprioceptive feedback, which would provide them with a greater awareness of their speaking behavior.

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Interaction of Speech Coders and Atypical Speech II

Journal of Speech Language and Hearing Research ◽

10.1044/1092-4388(2002/055) ◽

2002 ◽

Vol 45 (4) ◽

pp. 689-699 ◽

Cited By ~ 2

Author(s):

Donald G. Jamieson ◽

Vijay Parsa ◽

Moneca C. Price ◽

James Till

Keyword(s):

Communication Systems ◽

Speech Rate ◽

Voice Quality ◽

Voice Disorders ◽

Normal Hearing ◽

Speech Quality ◽

Degraded Speech ◽

Before And After ◽

Subband Processing

We investigated how standard speech coders, currently used in modern communication systems, affect the quality of the speech of persons who have common speech and voice disorders. Three standardized speech coders (GSM 6.10 RPELTP, FS1016 CELP, and FS1015 LPC) and two speech coders based on subband processing were evaluated for their performance. Coder effects were assessed by measuring the quality of speech samples both before and after processing by the speech coders. Speech quality was rated by 10 listeners with normal hearing on 28 different scales representing pitch and loudness changes, speech rate, laryngeal and resonatory dysfunction, and coder-induced distortions. Results showed that (a) nine scale items were consistently and reliably rated by the listeners; (b) all coders degraded speech quality on these nine scales, with the GSM and CELP coders providing the better quality speech; and (c) interactions between coders and individual voices did occur on several voice quality scales.

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