GRBAS and Cape-V Scales: High Reliability and Consensus When Applied at Different Times

Objectives. To evaluate whether the overall dysphonia grade, roughness, breathiness, asthenia, and strain (GRBAS) scale, and the Consensus Auditory Perceptual Evaluation-Voice (CAPE-V) scale show the same reliability and consensus when applied to the same vocal sample at different times. Study Design. Observational cross-sectional study. Methods. Sixty subjects had their voices recorded according to the tasks proposed in the CAPE-V scale. Vowels /a/ and /i/ were sustained between 3 and 5 seconds. Reproduction of six sentences and spontaneous speech from the request "Tell me about your voice" were analyzed. For the analysis of the GRBAS scale, the sustained vowel and reading tasks of the sentences was used. Auditory-perceptual voice analyses were conducted by three expert speech therapists with more than 5 years of experience and familiar with both the scales. Results. A strong correlation was observed in the intrajudge consensus analysis, both for the GRBAS scale as well as for CAPE-V, with intraclass coefficient values ranging from 0.923 to 0.985. A high degree of correlation between the general GRBAS and CAPE-V grades (coefficient = 0.842) was observed, with similarities in the grades of dysphonia distribution in both scales. The evaluators indicated a mild difficulty in applying the GRBAS scale and low to mild difficulty in applying the CAPE-V scale. The three evaluators agreed when indicating the GRBAS scale as the fastest and the CAPE-V scale as the most sensitive, especially for detecting small changes in voice. Conclusions. The two scales are reliable and are indicated for use in analyzing voice quality.

Modeling of GRBAS perceptual evaluation using spectral features obtained from an auditory-based filterbank.

Perceptual voice evaluation according to the GRBAS scale is modelled using a linear combination of acoustic parameters calculated after a filter-bank analysis of the recorded voice signals. Modelling results indicate that for breathiness and asthenia more than 55% of the variance of perceptual rates can be explained by such a model, with only 4 latent variables. Moreover, the greatest part of the explained variance can be attributed to only one or two latent variables similarly weighted by all 5 listeners involved in the experiment. Correlation factors between actual rates and model predictions around 0.6 are obtained.

Evaluación perceptivo auditiva de voces degradas y su correlación con medidas acústicas

Resumen: El objetivo es determinar utilizando las mediciones acústicas, qué información es más relevante para el oyente al momento de categorizar el grado general de disfonía. Se eligieron 8 (4 voces femeninas y 4 voces masculinas. Cada emisión fue evaluada auditivo perceptualmente a través del item G de la escala GRBAS por 10 oyentes experimentados y acústicamente mediante medidas de aperiodicidad, ruido y caos. El estudio estadístico de análisis discriminante señala la importancia de GNE, Jit y Jitter_cc y Lyapunov como parámetros predictores del grado general de disfonía. La aplicación del método k-means evidencia que existen rasgos en los parámetros acústicos empleados que permiten agrupar objetivamente las voces estudiadas con 100% de precisión para la clase 0, 96% a la clase 2 y 79% a la clase 3. Un mayor número y variabilidad de casos se necesita a fin de verificar los resultados preliminares.

Eficacia del tratamiento vocal rehabilitador en los pacientes con disfonías funcionales hipercinéticas.

Resumen en inglés. Resumen tomado de la publicación

Consequences of Chronic Nasal Obstruction on the Laryngeal Mucosa and Voice Quality of 4- to 12-Year-Old Children

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Mucosal Bridge of the Vocal Fold: Difficulties in the Diagnosis and Treatment

Mucosal bridges are rare laryngeal lesions probably of genetic origin. They may cause dysphonia of varying degrees, especially when associated with other laryngeal lesions such as vocal sulci and cysts. Reports on mucosal bridges are rare, and the better treatment is inconclusive.Aim. To report the authors' experience in 14 cases of mucosal bridge showing details on endoscopic examinations and treatment.Study Design. Retrospective study.Methods. We reviewed the medical records of 14 patients with a diagnosis of mucosal bridge confirmed by video-laryngostroboscopy and direct laryngoscopy who attended the Outpatient Clinic of Voice Disorders of the Discipline of Otorhinolaryngology, Botucatu Medical School, São Paulo State University, São Paulo. Data collected included information on gender, age, symptoms, time of onset, history of intubation, smoking status, alcohol intake, associated laryngeal lesions, treatment, and GRBAS (grade of hoarseness, roughness, breathiness, asthenia, and stress) scale ratings.Results. of 14 patients, 10 were females and four were males. There was a prevalence of adults (n = 12), with only two of the patients being younger than 13 years (10 and 13 years). Mucosal bridges showed no correlations with smoking, alcohol intake, or gastroesophageal and sinonasal symptoms. Voice abuse was reported in 50% of the cases that consisted of patients who had high-voice demand occupations. In seven cases, mucosal bridges were associated with other laryngeal lesions, particularly vocal cysts and sulci. All patients who underwent surgery and phonotherapy showed improved vocal quality.Conclusions. We documented 14 patients with dysphonia caused by mucosal bridge. Promising results were obtained with surgery.

Avaliação clínica, videolaringoscópica e vocal perceptivo-auditiva e acústica de professores disfônicos

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

The effect of noise on the voice of preschool institution educators

OBJECTIVE: To analyze the association between noise levels present in preschool institutions and vocal disorders among educators. METHODS: Cross-sectional study conducted in 2009 with 28 teachers from three preschool institutions located in the city of Sao Paulo (Southeastern Brazil). Sound pressure levels were measured according to Brazilian Technical Standards Association, with the use of a sound level meter. The averages were classified according to the levels of comfort, discomfort, and auditory damage proposed by the Pan American Health Organization. The educators underwent voice evaluation: self-assessment with visual analogue scale, auditory perceptual evaluation using the GRBAS scale, and acoustic analysis utilizing the Praat program. To analyze the association between noise and voice evaluation, descriptive statistics and the chi-square test were employed, with significance of 10% due to sample size. RESULTS: The teachers' age ranged between 21 and 56 years. The noise average was 72.7 dB, considered as damage 2. The professionals' vocal self-assessment ranked an average of 5.1 on the scale, being considered as moderate alteration. In the auditory-perceptual assessment, 74% presented vocal alteration, especially hoarseness; of these, 52% were considered mild alterations. In the acoustic assessment the majority presented fundamental frequency below the expected level. Averages for jitter, shimmer and harmonic-noise ratio showed alterations. An association between the presence of noise between the harmonics and vocal disorders was observed. CONCLUSIONS: There is an association between presence of noise between the harmonics and vocal alteration, with high noise levels. Although most teachers presented mild voice alteration, the self-evaluation showed moderate alteration, probably due to the difficulty in projection.

Impacto de treinamento auditivo na avaliação perceptivo-auditiva da voz realizada por estudantes de Fonoaudiologia

OBJETIVO: Analisar o impacto de treino auditivo na avaliação perceptivo-auditiva da voz realizada por estudantes de Fonoaudiologia. MÉTODOS: Durante dois semestres, 17 estudantes que cursavam disciplinas teóricas de fonação (Fonação/Distúrbios da Fonação) analisaram amostras de vozes alteradas e não alteradas (selecionadas para este estudo), por meio da escala GRBAS. Todos receberam treinamento auditivo durante um total de nove encontros semanais, com cerca de 15 minutos de duração cada. Em cada encontro foi apresentado um parâmetro, por meio de vozes diferentes da amostra avaliada, com predominância no aspecto treinado. A avaliação das amostras por meio da escala foi realizada pré e pós o treinamento e em outros quatro momentos ao longo dos encontros. As avaliações dos alunos foram comparadas com uma avaliação de juízas, realizada previamente por três fonoaudiólogos, especialistas em voz. Para verificar a efetividade do treinamento foi usado o teste de Friedman e Índice de Concordância Kappa. RESULTADOS: O índice de acertos dos alunos no momento pré-treinamento foi considerado entre regular e bom. Observou-se manutenção do número de acertos ao longo das avaliações realizadas, para a maioria dos parâmetros da escala. No momento pós-treinamento observou-se melhora na análise da astenia, parâmetro enfatizado a partir das dificuldades apresentadas pelos alunos. Houve diminuição dos acertos no parâmetro rugosidade após este ter sido trabalhado de maneira segmentada em rouquidão e aspereza, e associado a diferentes diagnósticos e parâmetros acústicos. CONCLUSÃO: O treino auditivo potencializa as habilidades iniciais dos alunos, refinando-as para realização da avaliação, além de nortear ajustes em dinâmicas das disciplinas.

Análisis de métodos de parametrización y clasificación para la simulación de un sistema de evaluación perceptual del grado de afección en voces patológicas

Los procedimientos de evaluación de la calidad de la voz basados en la valoración subjetiva a través de la percepción acústica por parte de un experto están bastante extendidos. Entre ellos,el protocolo GRBAS es el más comúnmente utilizado en la rutina clínica. Sin embargo existen varios problemas derivados de este tipo de estimaciones, el primero de los cuales es que se precisa de profesionales debidamente entrenados para su realización. Otro inconveniente reside en el hecho de que,al tratarse de una valoración subjetiva, múltiples circunstancias significativas influyen en la decisión final del evaluador, existiendo en muchos casos una variabilidad inter-evaluador e intra-evaluador en los juicios. Por estas razones se hace necesario el uso de parámetros objetivos que permitan realizar una valoración de la calidad de la voz y la detección de diversas patologías. Este trabajo tiene como objetivo comparar la efectividad de diversas técnicas de cálculo de parámetros representativos de la voz para su uso en la clasificación automática de escalas perceptuales. Algunos parámetros analizados serán los coeficientes Mel-Frequency Cepstral Coefficients(MFCC),las medidas de complejidad y las de ruido.Así mismo se introducirá un nuevo conjunto de características extraídas del Espectro de Modulación (EM) denominadas Centroides del Espectro de Modulación (CEM).En concreto se analizará el proceso de detección automática de dos de los cinco rasgos que componen la escala GRBAS: G y R. A lo largo de este documento se muestra cómo las características CEM proporcionan resultados similares a los de otras técnicas anteriormente utilizadas y propician en algún caso un incremento en la efectividad de la clasificación cuando son combinados con otros parámetros.

Multiparametric evaluation of dysphonic severity

In recent years, the multiparametric approach for evaluating perceptual rating of voice quality has been advocated. This study evaluates the accuracy of predicting perceived overall severity of voice quality with a minimal set of aerodynamic, voice range profile (phonetogram), and acoustic perturbation measures. One hundred and twelve dysphonic persons (93 women and 19 men) with laryngeal pathologies and 41 normal controls (35 women and six men) with normal voices participated in this study. Perceptual severity judgement was carried out by four listeners rating the G (overall grade) parameter of the GRBAS scale.(1) The minimal set of instrumental measures was selected based on the ability of the measure to discriminate between dysphonic and normal voices, and to attain at least a moderate correlation with perceived overall severity. Results indicated that perceived overall severity was best described by maximum phonation time of sustained /a/, peak intraoral pressure of the consonant-vowel /pi/ strings production, voice range profile area, and acoustic jitter. Direct-entry discriminant function analysis revealed that these four voice measures in combination correctly predicted 67.3% of perceived overall severity levels.