Vocal parameters to determine severity of voice disorders
Parámetros vocales para definir la severidad de una disfonía
Abstract
Introduction: the severity of dysphonia shows the degree of alteration that a voice has in relation to all the physiological processes involved in the production of sound. It is essential to determine the level of severity to establish a program with the set of exercises required for a proper rehabilitation.
Objective: to understand if the behavior of the different aerodynamic, electroglottographic, acoustic, and vocal self-report parameters allows, or not, to determine the severity of dysphonia.
Method: 55 subjects with different types of dysphonia were evaluated according to aerodynamic, electroglottographic, acoustic, and vocal self-report parameters. The sample was divided into three groups in relation to the severity degree of the pathology. An analysis of variance was applied to compare the behavior of dependent variables with the severity levels of dysphonia. The Post hoc test (Tukey) was applied to the significant variables to determine the differences between the severity levels.
Results: it is possible to determine the level of severity of dysphonia from acoustic parameters such as CPP, HNR, and the ratio of spectral slope 1 / 5-5 / 8Khz. It is also possible to use voice self-report questionnaires such as the VOISS, the VHI, and the VTDS.
Downloads
Citado por
Authors
Keywords
References
Szkiełkowska A, Krasnodębska P, Miaśkiewicz B, Włodarczyk E, Domeracka-Kolodziej A, Skarżyński H. Mucosal wave measurements in the diagnosis of functional dysphonia. Otolaryngol Pol = Polish Otolaryngol. 2019 Ag 2;73(6):1–7.DOI: https://doi.org/10.5604/01.3001.0013.3215
Snow G, Guardiani E. Movement Disorders and Voice. Vol. 52, Otolaryngologic Clinics of North America. W.B. Saunders; 2019 Ag;52(4):759–67. DOI: https://doi.org/10.1016/j.otc.2019.03.018
Kosztyła-Hojna B, Moskal D, Łobaczuk-Sitnik A, Kraszewska A, Zdrojkowski M, Biszewska J, et al. Psychogenic voice disorders. Otolaryngol Pol. 2018;72(4):26–34.DOI: https://doi.org/10.5604/01.3001.0012.0636
Gray SD, Hammond E, Hanson DF. Benign pathologic responses of the larynx. Ann Otol Rhinol Laryngol [Internet]. 1995 [cited 2020 Sep 11];104(1):13–8. Disponible en: https://pubmed.ncbi.nlm.nih.gov/7832537/ DOI: https://doi.org/10.1177/000348949510400103
Fulcher LP, Scherer RC. Phonation threshold pressure: Comparison of calculations and measurements taken with physical models of the vocal fold mucosa. J Acoust Soc Am [Internet]. 2011 Sep [cited 2020 Sep 11];130(3):1597–605. Disponible en: /pmc/articles/PMC3188973/?report=abstract DOI: https://doi.org/10.1121/1.3605672
Kandogan T, Seifert E. Influence of aging and sex on voice parameters in patients with unilateral vocal cord paralysis. Laryngoscope. 2009 Ene 03;115(4): 655–60. DOI: https://doi.org/10.1097/01.mlg.0000161344.23128.9d
Sivasankar M, Fisher K V. Oral breathing increases Pth and vocal effort by superficial drying of vocal fold mucosa. J Voice. 2002 Jun 01;16(2):172–81. DOI: https://doi.org/10.1016/S0892-1997(02)00087-5
Smitheran J, Hixon TJ. A clinical method for estimating laryngeal airway resistance during vowel production. J Speech Hear Disord [Internet]. 1981 [cited 2020 Sep 11];46(2):138–46. Disponible en: https://pubs.asha.org/doi/10.1044/jshd.4602.138 DOI: https://doi.org/10.1044/jshd.4602.138
Titze IR. Phonation threshold pressure: A missing link in glottal aerodynamics. J Acoust Soc Am [Internet]. 1992 May 26 [cited 2020 Sep 11];91(5):2926–35. Disponible en: http://asa.scitation.org/doi/10.1121/1.402928 DOI: https://doi.org/10.1121/1.402928
Titze IR, Švec JG, Popolo PS. Vocal dose measures: Quantifying accumulated vibration exposure in vocal fold tissues. J Speech, Lang Hear Res [Internet]. 2003 Aug [cited 2020 Sep 11];46(4):919–32. Disponible en: /pmc/articles/PMC3158591/?report=abstract DOI: https://doi.org/10.1044/1092-4388(2003/072)
Reghunathan S, Bryson PC. Components of Voice Evaluation. Otolaryngologic Clinics of North America. W.B. Saunders; 2019 Ago;52(4):589–95. DOI: https://doi.org/10.1016/j.otc.2019.03.002
Uloza V, Latoszek BB v., Ulozaite-Staniene N, Petrauskas T, Maryn Y. A comparison of Dysphonia Severity Index and Acoustic Voice Quality Index measures in differentiating normal and dysphonic voices. Eur Arch Oto-Rhino-Laryngology. 2018 Apr 1;275(4):949–58. DOI: https://doi.org/10.1007/s00405-018-4903-x
Lopes LW, Sousa ES da S, da Silva ACF, da Silva IM, de Paiva MAA, Vieira VJD, et al. Cepstral measures in the assessment of severity of voice disorders. CODAS. 2019;31(4).
Zhang Z. Mechanics of human voice production and control. J Acoust Soc Am [Internet]. 2016 Oct [cited 2020 Sep 10];140(4):2614–35. Disponible en: /pmc/articles/PMC5412481/?report=abstract DOI: https://doi.org/10.1121/1.4964509
Guzman M, Calvache Mora CA. Medidas aerodinámicas de la fonación: Bases teóricas y clínicas. Areté [Internet]. 2018;18(2 Sup):1–10. Disponible en: https://arete.ibero.edu.co/article/view/art.182S01 DOI: https://doi.org/10.33881/1657-2513.art.182S01
Chang A, Karnell MP. Perceived phonatory effort and phonation threshold pressure across a prolonged voice loading task: A study of vocal fatigue. J Voice [Internet]. 2004 Dec [cited 2020 Sep 11];18(4):454–66. Disponible en: https://pubmed.ncbi.nlm.nih.gov/15567047/ DOI: https://doi.org/10.1016/j.jvoice.2004.01.004
Enflo L, Sundberg J. Vocal fold collision threshold pressure: An alternative to phonation threshold pressure? Logop Phoniatr Vocology [Internet]. 2009 [cited 2020 Sep 11];34(4):210–7. Disponible en: https://pubmed.ncbi.nlm.nih.gov/19916893/ DOI: https://doi.org/10.3109/14015430903382789
Titze IR, Schmidt SS, Titze MR. Phonation threshold pressure in a physical model of the vocal fold mucosa. J Acoust Soc Am [Internet]. 1995 [cited 2020 Sep 11];97(5):3080–4. Disponible en: https://pubmed.ncbi.nlm.nih.gov/7759648/ DOI: https://doi.org/10.1121/1.411870
Pearl Solomon N, Stemmle DiMattia M. Effects of a vocally fatiguing task and systemic hydration on phonation threshold pressure. J Voice. 2000 Sep 1;14(3):341–62. DOI: https://doi.org/10.1016/S0892-1997(00)80080-6
Gray SD, Alipour F, Titze IR, Hammond TH. Biomechanical and histologic observations of vocal fold fibrous proteins. Ann Otol Rhinol Laryngol. 2000;109(1):77–85. DOI: https://doi.org/10.1177/000348940010900115
Titze IR. The physics of small-amplitude oscillation of the vocal folds. J Acoust Soc Am [Internet]. 1988 [cited 2020 Sep 11];83(4):1536–52. Disponible en: https://pubmed.ncbi.nlm.nih.gov/3372869/ DOI: https://doi.org/10.1121/1.395910
Verdolini-Marston K, Titze IR, Druker DG. Changes in phonation threshold pressure with induced conditions of hydration. J Voice. 1990 Jan 1;4(2):142–51. DOI: https://doi.org/10.1016/S0892-1997(05)80139-0
Roy N, Tanner K, Gray SD, Blomgren M, Fisher K V. An evaluation of the effects of three laryngeal lubricants on phonation threshold pressure (PTP). J Voice. 2003 Sep 1;17(3):331–42. DOI: https://doi.org/10.1067/S0892-1997(03)00078-X
Roy N, Tanner K, Gray SD, Blomgren M, Fisher K V. An evaluation of the effects of three laryngeal lubricants on phonation threshold pressure (PTP). J Voice [Internet]. 2003 [cited 2020 Sep 11];17(3):331–42. Disponible en: https://pubmed.ncbi.nlm.nih.gov/14513956/ DOI: https://doi.org/10.1067/S0892-1997(03)00078-X
Milbrath RL, Solomon NP. Do vocal warm-up exercises alleviate vocal fatigue? J Speech, Lang Hear Res [Internet]. 2003 Apr [cited 2020 Sep 11];46(2):422–36. Disponible en: https://pubmed.ncbi.nlm.nih.gov/14700383/ DOI: https://doi.org/10.1044/1092-4388(2003/035)
Wuyts FL, De Bodt MS, Molenberghs G, Remacle M, Heylen L, Millet B, et al. The Dysphonia Severity Index: An Objective Measure of Vocal Quality Based on a Multiparameter Approach. J Speech, Lang Hear Res [Internet]. 2000 [cited 2020 Sep 11];43(3):796–809. Disponible en: https://pubmed.ncbi.nlm.nih.gov/10877446/ DOI: https://doi.org/10.1044/jslhr.4303.796
Guzman M, Saldivar P, Pérez R, Muñoz D. Aerodynamic, Electroglottographic, and Acoustic Outcomes after Tube Phonation in Water in Elderly Subjects. Folia Phoniatr Logop. 2018 Oct 1;70(3–4):149–55. DOI: https://doi.org/10.1159/000492326
Behlau M. The 2016 G. Paul Moore Lecture: Lessons in Voice Rehabilitation: Journal of Voice and Clinical Practice. J Voice [Internet]. 2019 Sep 1 [cited 2020 Sep 11];33(5):669–81. Disponible en: https://pubmed.ncbi.nlm.nih.gov/29567050/ DOI: https://doi.org/10.1016/j.jvoice.2018.02.020
Calvache Mora CA. Objetividad de la electroglotografía. Aplicaciones clínicas e investigativas en la voz. Revista de Logopedia, Foniatria y Audiologia.2015 Jul-Sep;35(3):134–42. DOI: https://doi.org/10.1016/j.jvoice.2018.02.020
Guzman M, Calvache C, Romero L, Muñoz D, Olavarria C, Madrid S, et al. Do Different Semi-Occluded Voice Exercises Affect Vocal Fold Adduction Differently in Subjects Diagnosed with Hyperfunctional Dysphonia? Folia Phoniatr Logop. 2015;67(2):68–75. DOI: https://doi.org/10.1159/000437353
Guzman M, Calvache C, Romero L, Muñoz D, Olavarria C, Madrid S, et al. Do Different Semi-Occluded Voice Exercises Affect Vocal Fold Adduction Differently in Subjects Diagnosed with Hyperfunctional Dysphonia? Folia Phoniatr Logop [Internet]. 2015 Dec 1 [cited 2020 Sep 11];67(2):68–75. Disponible en: https://pubmed.ncbi.nlm.nih.gov/26394210/ DOI: https://doi.org/10.1159/000437353
Colton RH, Casper JK, Leonard RJ. Understanding voice problem: A physiological perspective for diagnosis and treatment: Fourth edition [Internet]. Wolters Kluwer Health Adis (ESP); 2011 [cited 2020 Sep 11]. Disponible en: https://ucdavis.pure.elsevier.com/en/publications/understanding-voice-problem-a-physiological-perspective-for-diagn
Nemr K, Simões-Zenari M, Cordeiro GF, Tsuji D, Ogawa AI, Ubrig MT, et al. GRBAS and cape-V scales: High reliability and consensus when applied at different times. J Voice [Internet]. 2012 [cited 2020 Sep 11];26(6):812.e17-812.e22. Disponible en: https://pubmed.ncbi.nlm.nih.gov/23026732/ DOI: https://doi.org/10.1016/j.jvoice.2012.03.005
Lin FC, Chen SH, Chen SC, Wang C Te, Kuo YC. Correlation Between Acoustic Measurements and Self-Reported Voice Disorders Among Female Teachers. J Voice. 2016 Jul 1;30(4):460–5. DOI: https://doi.org/10.1016/j.jvoice.2015.05.013
Mehta DD, Cheyne HA, Wehner A, Heaton JT, Hillman RE. Accuracy of self-reported estimates of daily voice use in adults with normal and disordered voices. Am J Speech-Language Pathol. 2016 Nov 1;25(4):634–41. DOI: https://doi.org/10.1044/2016_AJSLP-15-0105
Scech M. Voice Handicap Index – efficiency and correlation between physical, functional and emotional aspects and voice disorders. Pomeranian J life Sci. 2016 Jan 1;62(1):9–15.
Lopes LW, de Oliveira Florencio V, Silva POC, da Nóbrega e Ugulino AC, Almeida AA. Vocal Tract Discomfort Scale (VTDS) and Voice Symptom Scale (VoiSS) in the Evaluation of Patients With Voice Disorders. J Voice. 2019 May 1;33(3):381.e23-381.e32. DOI: https://doi.org/10.1016/j.jvoice.2017.11.018
Lopes LW, Cabral GF, Figueiredo De Almeida AA. Vocal tract discomfort symptoms in patients with different voice disorders. J Voice. 2015 May 1;29(3):317–23. DOI: https://doi.org/10.1016/j.jvoice.2014.07.013
Wilson JA, Webb A, Carding PN, Steen IN, Mackenzie K, Deary IJ. The Voice Symptom Scale (VoiSS) and the Vocal Handicap Index (VHI): A comparison of structure and content. Clin Otolaryngol Allied Sci. 2004 Apr;29(2):169–74. DOI: https://doi.org/10.1111/j.0307-7772.2004.00775.x
Martins PC, Couto TE, Gama ACC. Auditory-perceptual evaluation of the degree of vocal deviation: Correlation between the Visual Analogue Scale and Numerical Scale. CODAS. 2015;27(3):279–84. DOI: https://doi.org/10.1590/2317-1782/20152014167
Naunheim MR, Dai JB, Rubinstein BJ, Goldberg L, Weinberg A, Courey MS. A visual analog scale for patient-reported voice outcomes: The VAS voice. Laryngoscope Investig Otolaryngol [Internet]. 2020 Feb [cited 2020 Sep 12];5(1):90–5. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/32128435 DOI: https://doi.org/10.1002/lio2.333
Lee YW, Kim GH, Bae IH, Park HJ, Wang SG, Kwon SB. The cut-off analysis using visual analogue scale and cepstral assessments on severity of voice disorder. Logop Phoniatr Vocology. 2018 Oct 2;43(4):175–80. DOI: https://doi.org/10.1080/14015439.2018.1461925
Borel F, Tresallet C, Hamy A, Mathonnet M, Lifante JC, Brunaud L, et al. Self-assessment of voice outcomes after total thyroidectomy using the Voice Handicap Index questionnaire: Results of a prospective multicenter study. Surgery. 2019 Sep 13;167(1):129–36. DOI: https://doi.org/10.1016/j.surg.2019.05.090
Bultynck C, Pas C, Defreyne J, Cosyns M, den Heijer M, T’Sjoen G. Self-perception of voice in transgender persons during cross-sex hormone therapy. Laryngoscope. 2017 Dic 1;127(12):2796–804. DOI: https://doi.org/10.1002/lary.26716
Cohen W, Lloyd S, Wynne DM, Townsley RB. Perceptual evaluation of voice disorder in children who have had laryngotracheal reconstruction surgery and the relationship between clinician perceptual ratingof voice quality and parent proxy/child self-report of voice-related quality of life. J Voice. 2019 Nov 1;33(6):945.e27-945.e35. DOI: https://doi.org/10.1016/j.jvoice.2018.07.009
Phadke KV, Laukkanen AM, Ilomäki I, Kankare E, Geneid A, Švec JG. Cepstral and perceptual investigations in female teachers with functionally healthy voice. J Voice. 2018 Oct 19;34(3):485.e33-485.e43 DOI: https://doi.org/10.1016/j.jvoice.2018.09.010
Delgado-Hernández J, León-Gómez NM, Izquierdo-Arteaga LM, Llanos-Fumero Y. Cepstral analysis of normal and pathological voice in Spanish adults. Smoothed cepstral peak prominence in sustained vowels versus connected speech. Acta Otorrinolaringol Esp. 2018 May 1;69(3):134–40. DOI: https://doi.org/10.1016/j.otoeng.2017.05.002
Rieves AL, Regner MF, Jiang JJ. Phonation threshold pressure estimation using electroglottography in an airflow redirection system. Laryngoscope. 2009 Dic;119(12):2378–83. DOI: https://doi.org/10.1002/lary.20611
Björklund S, Sundberg J. Relationship between subglottal pressure and sound pressure level in untrained voices. Journal of Voice. 2016 Ene 01;30(1):15–20. DOI: https://doi.org/10.1016/j.jvoice.2015.03.006
Barone NA, Ludlow CL, Tellis CM. Acoustic and aerodynamic comparisons of voice qualities produced after voice training. J Voice [Internet]. 2019 Sep 3 [cited 2020 Sep 12]; Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/31492513DOI: https://doi.org/10.1016/j.jvoice.2019.07.011
Titze IR. Phonation threshold pressure measurement with a semi-occluded vocal tract. J Speech, Lang Hear Res. 2009 Aug 1;52(4):1062–72. DOI: https://doi.org/10.1044/1092-4388(2009/08-0110)
Jiang J, O’Mara T, Conley D, Hanson D. Phonation threshold pressure measurements during phonation by airflow interruption. Laryngoscope. 1999;109(3):425–32. DOI: https://doi.org/10.1097/00005537-199903000-00016
Plexico LW, Sandage MJ, Faver KY. Assessment of phonation threshold pressure: a critical review and clinical implications. Am J speech-language Pathol [Internet]. 2011 Nov [cited 2020 Sep 12];20(4):348–66. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/21856967 DOI: https://doi.org/10.1044/1058-0360(2011/10-0066)
Sundberg J, Scherer R, Hess M, Müller F, Granqvist S. Subglottal pressure oscillations accompanying phonation. J Voice. 2013 Jul;27(4):411–21. DOI: https://doi.org/10.1016/j.jvoice.2013.03.006
Mora R, Jankowska B, Guastini L, Santomauro V, Dellepiane M, Crippa B, et al. Computerized voice therapy in hypofunctional dysphonia. J Otolaryngol - Head Neck Surg. 2010 Oct;39(5):615–21
Kosztyła-Hojna B, Moskal D, Kuryliszyn-Moskal A. Parameters of the assessment of voice quality and clinical manifestation of rheumatoid arthritis. Adv Med Sci. 2015 Sep 26;60(2):321–8. DOI: https://doi.org/10.1016/j.advms.2015.06.004
Szklanny K, Gubrynowicz R, Ratyńska J, Chojnacka-Wądołowska D. Electroglottographic and acoustic analysis of voice in children with vocal nodules. Int J Pediatr Otorhinolaryngol. 2019 Jul 1;122:82–8. DOI: https://doi.org/10.1016/j.ijporl.2019.03.030
Calvache C, Guzman M, Bobadilla M, Bortnem C. Variation on vocal economy after different semioccluded vocal tract exercises in subjects with normal voice and dysphonia. J Voice. 2020 Jul 1;34(4):582–9.DOI: https://doi.org/10.1016/j.jvoice.2019.01.007
Guzman M, Calvache C, Romero L, Muñoz D, Olavarria C, Madrid S, et al. Do different semi-occluded voice exercises affect vocal fold adduction differently in subjects diagnosed with hyperfunctional dysphonia? Folia Phoniatr Logop. 2015 Dec 1;67(2):68–75. DOI: https://doi.org/10.1159/000437353
Vieira MN, McInnes FR, Jack MA. On the influence of laryngeal pathologies on acoustic and electroglottographic jitter measures. J Acoust Soc Am. 2002 Feb;111(2):1045–55. DOI: https://doi.org/10.1121/1.1430686
Mendoza E, Valencia N, Muñoz J, Trujillo H. Differences in voice quality between men and women: Use of the long-term average spectrum (LTAS). J Voice. 1996;10(1):59–66. DOI: https://doi.org/10.1016/S0892-1997(96)80019-1
Izdebski K. Overpressure and breathiness in spastic dysphonia: An acoustic (LTAS) and perceptual study. Acta Otolaryngol. 1984;97(3–4):373–8. DOI: https://doi.org/10.3109/00016488409131003
Thuesen MA, McGlashan J, Sadolin C. Curbing—the metallic mode in-between: an empirical study qualifying and categorizing restrained sounds known as curbing based on audio perception, laryngostroboscopic imaging, acoustics, LTAS, and EGG. J Voice. 2017 Sep 1;31(5):644.e1-644.e10. DOI: https://doi.org/10.1016/j.jvoice.2017.01.010
McGlashan J, Thuesen MA, Sadolin C. Overdrive and edge as refiners of “belting”?: an empirical study qualifying and categorizing “belting” based on Audio Perception, Laryngostroboscopic Imaging, Acoustics, LTAS, and EGG. J Voice. 2017 May 1;31(3):385.e11-385.e22. DOI: https://doi.org/10.1016/j.jvoice.2016.09.006
Szkiełkowska A, Krasnodębska P, Miaśkiewicz B, Skarżyński H. Electroglottography in the diagnosis of functional dysphonia. Eur Arch Oto-Rhino-Laryngology. 2018 Oct 1;275(10):2523–8. DOI: https://doi.org/10.1007/s00405-018-5012-6
Article Sidebar
PDF (Español (España))
FLIP
Texto completo (Español (España))
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0).