Do Standard Instrumental Acoustic, Perceptual, and Subjective Voice Outcomes Indicate Therapy Success in Patients With Functional Dysphonia?

Stephanie Reetz; Joerg E Bohlender; Meike Brockmann-Bauser

doi:10.1016/j.jvoice.2017.11.014

Do Standard Instrumental Acoustic, Perceptual, and Subjective Voice Outcomes Indicate Therapy Success in Patients With Functional Dysphonia?

J Voice. 2019 May;33(3):317-324. doi: 10.1016/j.jvoice.2017.11.014. Epub 2018 Feb 1.

Authors

Stephanie Reetz¹, Joerg E Bohlender¹, Meike Brockmann-Bauser²

Affiliations

¹ Department of Phoniatrics and Speech Pathology, Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
² Department of Phoniatrics and Speech Pathology, Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland. Electronic address: meike.brockmann-bauser@usz.ch.

PMID: 29395329
DOI: 10.1016/j.jvoice.2017.11.014

Abstract

Objectives: The validity and sensitivity to change of instrumental acoustic measurements in patients with functional dysphonia have been controversially discussed. This work examines combined voice therapy effects on standard acoustic measurements, and if these agree with perceptual and subjective voice outcomes.

Study design: Retrospective study.

Methods: Thirty-nine patients (26 women, 13 men) aged 20-70 years (mean: 46.3, standard deviation 12.8) with functional dysphonia were investigated before and after combined voice therapy. Instrumental parameters included mean and range of speaking fundamental frequency (f_o) and intensity (SPL (dBA)); maximum SPL and mean f_o of calling voice; minimum, maximum, range of singing voice f_o and SPL, jitter (%), and the Dysphonia Severity Index. Voice Handicap Index-9 international was used for subjective and Grading-Roughness-Breathiness-Asthenia-Strain scale for perceptual assessment. Differences were investigated by Wilcoxon signed ranks test and coherences by Spearman rank correlation coefficient.

Results: After treatment, the speaking voice f_o range (7-8.13 semitones) and SPL range (12.9-14.85 dB(A)) were significantly larger (P < 0.05). Both parameters were highly correlated (P < 0.001). Subjective symptoms were significantly reduced from a mean Voice Handicap Index-9 international of 15.6-8.6, and all perceptual Grading-Roughness-Breathiness-Asthenia-Strain scale parameters were significantly improved (G: 1.05-0.51) after therapy (P < 0.05). These findings were not associated with any acoustic parameter (P > 0.05).

Conclusions: Significantly improved subjective and perceptual findings verify positive combined voice therapy effects in patients with functional dysphonia. The larger f_o and SPL speaking voice range after treatment indicate an altered voice technique. These instrumental measures may be clinical indicators of therapy success and transfer effects.

Keywords: Functional dysphonia; GRBAS scale; Instrumental acoustic measurements; Therapy outcome; VHI-9i.

MeSH terms

Acoustics*
Adult
Aged
Disability Evaluation*
Dysphonia / diagnosis
Dysphonia / physiopathology
Dysphonia / therapy*
Female
Humans
Judgment
Male
Middle Aged
Predictive Value of Tests
Recovery of Function
Reproducibility of Results
Retrospective Studies
Severity of Illness Index
Speech Acoustics*
Speech Perception*
Speech Production Measurement*
Surveys and Questionnaires*
Treatment Outcome
Voice Quality*
Voice Training*
Young Adult