Clinical examination of voice

Researchers evaluating voice disorder interventions currently have a plethora of voice outcome measurement tools from which to choose. Faced with such a wide choice, it would be beneficial to establish a clear rationale to guide selection. This article reviews the published literature on the three main areas of voice outcome assessment: (1) perceptual rating of voice quality, (2) acoustic measurement of the speech signal and (3) patient self-reporting of voice problems. We analysed the published reliability, validity, sensitivity to change and utility of the common outcome measurement tools in each area. From the data, we suggest that routine voice outcome measurement should include (1) an expert rating of voice quality (using the Grade-Roughness-Breathiness-Asthenia-Strain rating scale) and (2) a short self-reporting tool (either the Vocal Performance Questionnaire or the Vocal Handicap Index 10). These measures have high validity, the best reported reliability to date, good sensitivity to change data and excellent utility ratings. However, their application and administration require attention to detail. Acoustic measurement has arguable validity and poor reliability data at the present time. Other areas of voice outcome measurement (e.g. stroboscopy and aerodynamic phonatory measurements) require similarly detailed research and analysis.

/pdf/measuring-voice-outcomes-state-of-the-science-review-1yhw2ybfzf.pdf

Measuring voice outcomes: state of the science review.

Perception of Voice in the Transgender Client

The role of experience on judgments of dysphonia.

Purpose To determine the effect of auditory anchors on judgments of overall severity (OS) and vocal effort (VE) in dysphonic speech when judgments are made by experienced and inexperienced listener...

The effect of listener experience and anchors on judgments of dysphonia.

Objectives: To provide preliminary data on the reliability and validity of dysphonic patients rating their own voice quality.

Design:  Prospective reliability/validity assessment of voice ratings in dysphonic patients.

Setting:  The Royal Free Hampstead NHS Primary Care Trust.

Participants:  Thirty-five adult dysphonia patients recruited from ENT referrals to a speech and language therapy department. Exclusion criteria were (i) a hearing impairment which may affect auditory discrimination and (ii) a diagnosis of cognitive impairment which may affect task comprehension.

Main outcome measures:  Patient intra-rater reliability was assessed by test–retest ratings, using G (Grade), R (Rough), B (Breathy), A (Asthenic), S (Strained) (GRBAS). Validity was assessed by comparing (i) patient–clinician inter-rater reliability, (ii) patients’ GRBAS ratings with their Vocal Performance Questionnaire (VPQ) responses.

Result:  (i) Patients had lower intrarater reliability than clinicians (for G of GRBAS, kappa = 0.51 versus 0.74); (ii) patients consistently rated their voices more severely than clinicians (for G of GRBAS, mean rating = 1.4 versus 1.0); (iii) clinician–patient inter-rater agreement was no better than chance (paired t-test, all P   0.4, P < 0.05).

Conclusions:  Patients appear to have good validity and consistency using GRBAS as a self-perception tool. However, validity measured in terms of agreement with clinician ratings is poor. Voice patients may rate what they perceive rather than what they hear. Disagreement between patient and clinician ratings has implications for therapy aims, prognosis, patient expectations and outcomes. Where disagreement persists, the clinician may have to determine whether therapy priorities need redesigning to reflect patients’ perceived needs, or to evaluate whether patient perceptions and expectations are unrealistic.

M. Lee

Papers

The reliability and validity of patient self-rating of their own voice quality