دکتر فرهاد ترابی نژاد

This research aims to evaluate the validity and reliability of the Persian version of the voice symptom scale (VoiSS) questionnaire. We also sought to determine the best cut-off point to classify high-risk populations into controls (participants) and dysphonic patients. 

The study was conducted in 3 main steps. The translation process was carried out by a pair of Iranian bilingual speech-language pathologists along with an expert panel. For the validity study, the questionnaire was administered to 268 cases that were suspected of dysphonia. Finally, to assess the reliability, the questionnaire was completed twice in 2 weeks by 40 dysphonia patients. To normalize data generation 107 individuals without dysphonia completed the P-VoiSS, after that the cutoff value of the P-VoiSS was calculated.

Cronbach’s α was estimated at 0.914, and for impairment, emotional, and physical domains, it was 0.877, 0.926, and 0.725, respectively. We also estimated intra-cluster correlation (ICC) of 0.984 indicating high reproducibility of the Persian VoiSS questionnaire. The estimated intra-cluster correlation (ICC) for subscale was 0.962 for impairment, 0.989 for emotional, and 0.952 for physical domains. The Mean±SD score of the questionnaire for the healthy group was 10.1±5.9, while it was statistically higher in dysphonia patients (44.1±20.6). The statistical difference was observed in the subscales of the questionnaire between healthy and dysphonia groups (P<0.05). The exploratory factor analysis determined that the Persian VoiSS has three subtest/latent factors like the original form. We also estimate the best cut-point at 20.5. 

The Persian adaptation of VoiSS is a dependable and effective tool that can be utilized for screening high-risk populations.

Voice assessment is one of the five universal parameters in assessing the speech ability of children with cleft palate. One of the characteristics of cleft palate children is the production of compensatory errors. This study aims to compare the acoustic characteristics of the voice, including fundamental frequency, jitter, shimmer, and average harmonic to noise ratio in cleft palate children compared to their normal peers.

A total of 38 children in the age range of 48 to 60 months (17 children with cleft palate and 21 normal peers) participated in this descriptive-analytical and cross-sectional study. The children were asked to produce sustained vowels /a/ and /i/ while their speech samples were being recorded. The acoustic characteristics of the children’s voices were analyzed via the Praat software.

There were no statistically significant differences in acoustic parameters between the cleft palate children with and without compensatory errors. There were significant differences between children with cleft palate compared to their normal peers in the jitter averages of the vowel /a/ (P=0.05). The gender differences were found in the harmonic to noise ratio averages of the vowel /a/ between children with cleft palate (P=0.02).

Young children with velopharyngeal insufficiency may be at risk of voice problems.

Auditory perceptual assessment is one of the important evaluations for voice assessment. Among the available auditory-perceptual assessments, the grade, roughness, breathiness, asthenia, strain (GRBAS) auditory perceptual scale has attracted the attention of many researchers and therapists in Iran and other parts of the world. The GRBAS scale is a perceptual voice assessment scale that subjectively assesses voice quality; however, the audio samples in the original GRBAS scale that are used as training tools for raters are Japanese. There are various segmental and suprasegmental differences between the Japanese and Persian languages since these factors can affect the accuracy of the perceptual evaluation. 

This research aims to investigate the inter-rater agreement among the Persian raters who only had access to the Japanese samples in the main profile.

In this study, 8 speech and language pathologists were selected as raters with more than 5 years of clinical experience in evaluating and treating voice disorders. Several 137 audio samples, containing the prolongation of vowel /a/ and reading the standard text “Grandfather Passage” were provided to the participating raters. The raters were asked to score the audio samples based on the GRBAS auditory perceptual scale. The results were statistically analyzed via the Cohen kappa coefficient.

The highest agreement in the R parameter was related to rater number 5 (kappa=0.585) while the lowest value was related to parameter S, related to rater number 1 (kappa=-0.018).

According to the results, the clinical experience of raters using the Japanese samples cannot lead to an increase in the agreement and ability of Persian-speaking raters in evaluating Persian samples.

The present study examined the relationship between the total score of the voice handicap index (VHI) and the total score and scores of the three factors of the vocal fatigue index (VFI) with the medical history of Melli bank workers working in Tehran and Kurdistan privences.

The research is a descriptive-analytical cross-sectional study that was conducted on 444 clerks of Melli Bank branches in Iran (76% male and 24% female with a mean age of 42.3). A demographic questionnaire, the medical history checklist, and the Persian version of VHI and VFI were used to collect data.

The voice handicap index had a significant relationship with a history of neurological (P=0.030) and head and neck (P=0.048) disorders, speech and language disorders (P=0.001), and reflux (P=0.041). Regarding vocal fatigue index, the total score had a significant relationship with head and neck (P=0.006) and speech and language disorders (P<0.001); the first factor with diseases of the head and neck (P=0.018), pharynx and larynx (P=0.005) and speech and language disorders (P=0.001), the second factor with neurological (P=0.020), head and neck (P=0.006), and speech and language disorders (P<0.001), and allergies (P=0.032), and finally, the third factor with neurological (0.044), pharynx and larynx (P=0.031), speech and language disorders (P=0.044), and reflux (P=0.021).

Regardless of the respiratory system, suffering from diseases of the speech and language system can have a significant effect on the scores of the VHI and VFI indices. Meanwhile, the history of speech and language problems and head and neck disorders affect the total score of most factors of the VFI.

The singing voice handicap index (SVHI) was developed to assess voice-related handicaps in singers.

The purpose of this study was to evaluate the validity and reliability of a Persian translation of the SVHI (P-SVHI) for traditional Persian singers.

A cross-sectional study was performed to translate and validate the P-SVHI using a "forward-backward" procedure. The questionnaire was administered to 275 traditional Persian singers (168 with a normal voice and 107 with dysphonia) ranging from 16 to 83 years. Content, construct, discriminant, convergent, and face validity, test-retest reliability, internal consistency, and floor and ceiling effects were assessed.

The 36-item SVHI, translated from the original English by two translators, was completed by 21 traditional Persian singers. After the face validity was approved, construct validity assessment using factor analysis identified four factors in the P-SVHI with the exclusion of seven items. The mean score of the 29-item P-SVHI on a 0 - 100 scale was 16.9 for healthy subjects and 40.9 for dysphonic subjects. Discriminant validity confirmed that P-SVHI scores were significantly different between normal and dysphonic singers, using an independent sample t-test (P < 0.001). Convergent validity was proven by strong correlations between P-SVHI scores and the Iowa Patient’s Voice Index (IPVI1, IPVI2, and "IPVI effort" scores of r = 0.58, 0.69, and 0.42, respectively, P < 0.001). Internal consistency and test-retest reliability were also excellent (Cronbach α = 0.95, average inter-item correlation = 0.40, and intra-class correlation coefficients using two-way random model with absolute agreement, ICCtwo-way random, absolute agreement = 0.69 - 0.95). No floor or ceiling effects were observed.

The revised 29-item P-SVHI is a valid and reliable tool in differentiating normal and dysphonic Persian traditional singers.

Voice is influenced by personality. However, it is still questionable which acoustic features are influenced by personality traits. This study aimed to investigate the relationship between acoustic characteristics and personality dimensions.

Thirty-three participants with dysphonia and 33 participants without dysphonia were recruited to take part in this cross-sectional study. Personality dimensions were evaluated by the revised NEO personality inventory, and acoustic characteristics by using the Praat software. The tasks included prolongation of the vowel /a/, expression of declarative and interrogative sentences, reading, and connected speech. The acoustic features included fundamental frequency range, jitter, shimmer, harmonic-to-noise ratio, intensity, and duration. SPSS V. 23 was used for statistical analysis. For correlation analysis, the Pearson and Spearman correlation coefficients were employed.

In individuals with dysphonia, a significant relationship was observed between personality dimensions and the following acoustic features: A. extraversion and intensity in connected speech (P=0.045) and the reading task (P=0.036); B. openness and shimmer in /a/ vowel prolongation (P=0.003); C. openness and the harmonic-to-noise ratio in /a/ the vowel prolongation task (P=0.017); and D. agreeableness and duration in expressing interrogative sentences (P=0.019).

In Persian-speaking participants with and without dysphonia, some acoustic characteristics were significantly correlated with the mean score of the personality test (revised NEO personality inventory). It seems that each voice feature is influenced by personality dimensions. This finding indicates that changes in acoustic characteristics of voice due to personality can be evaluated in laboratory and hearing examinations.

Patients with muscle tension dysphonia (MTD) suffer from several physical discomforts in their vocal tract. However, few studies have examined the effects of voice therapy (VT) on the vocal tract discomfort (VTD) in patients with voice disorders. Therefore, the aim of the present study was to investigate the effects of VT on the VTD in patients with MTD.   This study was carried out on 25 subjects with MTD, including 5 men and 20 women, with the mean age of 37.20±5.70 years. The participants underwent 10 consecutive sessions of VT twice a week. The acoustic voice analysis, auditory-perceptual assessment, and the Persian version of the vocal tract discomfort (VTDp) scale were used to compare the pre- and post-treatment results.   After VT, significant improvements were observed in the acoustic characteristics, including jitter, shimmer, and harmonics-to-noise ratio (P<0.05). Regarding the auditory-perceptual assessment, a significant reduction was noticed in the overall severity, roughness, and breathiness (P<0.05). Moreover, VT led to a significant reduction in all the items of the VTDp, including burn, tightness, dryness, pain, tickling, soreness, irritability, and lump in the throat, after VT in both frequency and severity sections of the VTDp scale (P<0.05).   The results of the present study showed that VT can be effective in reducing the frequency and severity of the VTD in patients with MTD in addition to improving voice quality.