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This study aimed to explore the influence of gender and age on the Nasality Severity Index 2.0 (NSI 2.0), an instrumental multiparametric index to determine hypernasality. Additionally, reference values will be established for this new index. Influence of gender and age on the NSI 2.0 was explored in 80 Flemish-speaking children (4-12 years; 40 boys, 40 girls) and 60 Flemish-speaking adults (18-60 years, 30 men, 30 women) without resonance disorders by determining its incorporated acoustic parameters: nasalance of the vowel/u/and an oral text, determined by a Nasometer, and voice low tone to high tone ratio (VLHR) of the vowel/i/. The equation yields NSI 2.0 = 13.20 - (0.0824 × nasalance/u/(%)) - (0.26 × nasalance oral text (%)) - (0.242 × VLHR/i/4.47*F0 Hz (dB)). No effect of gender or age was found on the NSI 2.0 in children. However, significant differences were found for the NSI 2.0, nasalance of/u/and an oral text between adult men and women. Additionally, an interaction effect between gender and age was found for these parameters. Consequently, separate reference values for the NSI 2.0 in children, adult men and adult women were established. Based on these reference scores, deviation of the NSI 2.0 score in patients with resonance disorders can be defined, which can determine the need for (additional) intervention. Further research can explore the possible influence of language on the index.

Purpose: The Nasality Severity Index 2.0 (NSI 2.0) forms a new, multiparametric approach in the assessment of hypernasality. To enable clinical implementation of this index, the short- and long-term test-retest reliability of this index was explored., Methods: In 40 normal-speaking adults (mean age 32y, SD 11, 18-56y) and 29 normal-speaking children (mean age 8y, SD 2, 4-12y), the acoustic parameters included in the NSI 2.0 (i.e. nasalance of the vowel /u/ and an oral text, and the voice low tone to high tone ratio (VLHR) of the vowel /i/) were obtained twice at the same test moment and during a second assessment two weeks later. After determination of the NSI 2.0, a comprehensive set of statistical measures was applied to determine its reliability., Results: Long-term variability of the NSI 2.0 and its parameters was slightly higher compared to the short-term variability, both in adults and in children. Overall, a difference of 2.82 for adults and 2.68 for children between the results of two consecutive measurements can be interpreted as a genuine change. With an ICC of 0.84 in adults and 0.77 in children, the NSI 2.0 additionally shows an excellent relative consistency. No statistically significant difference was withheld in the reliability of test-retest measurements between adults and children., Conclusion: Reliable test-retest measurements of the NSI 2.0 can be performed. Consequently, the NSI 2.0 can be applied in clinical practice, in which successive NSI 2.0 scores can be reliably compared and interpreted., Learning Outcomes: The reader will be able to describe and discuss both the short-term and long-term test-retest reliability of the Nasality Severity Index 2.0, a new multiparametric approach to hypernasality, and its parameters. Based on this information, the NSI 2.0 can be applied in clinical practice, in which successive NSI 2.0 scores, e.g. before and after surgery or speech therapy, can be compared and interpreted., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objective: Due to the multidimensional nature of resonance disorders, multivariate diagnostic assessment is advisable. The nasality severity index (NSI) is based on this point of view. Because of the influence of personal and environmental variables on the current NSI, this study aims to refine this index., Design: Prospective case-control study., Setting: Tertiary university hospital., Patients: Forty-two patients with cleft lip and palate and 50 children without resonance disorders were tested., Interventions: Resonance was investigated by perceptual as well as objective measurements. A Nasometer was used to score nasalance, and spectral speech characteristics of a sustained sound /i:/ were determined, among which the voice low tone to high tone ratio (VLHR). Binary logistic regression analysis was performed to calculate the optimal index to discriminate patients from control children. Additionally, the validity of the index was determined based on data from an independent patient and control group., Results: The NSI 2.0, a weighted linear combination of three variables, can be obtained using the equation NSI 2.0 = 13.20 - (.0824 × nasalance /u:/ [%]) - (.260 × nasalance oral text [%]) - (.242 × VLHR 4.47*F0 [dB]). The NSI has a sensitivity of 92% and a specificity of 100%. Moreover, it has excellent validity (sensitivity 88%, specificity 89%)., Conclusions: The NSI 2.0 discriminates patients from control children with high sensitivity, specificity, and validity. This multiparametric method can offer a more powerful approach in the assessment and treatment planning of individuals with hypernasality.

Objective: The purpose of this retrospective study was to determine the vocal characteristics of a treatment-seeking population with the primary complaint of vocal fatigue (VF)., Methods: Forty-three men (mean age 42 years, range 19-69) and 145 women (mean age 34 years, range 18-68) were included. None of the subjects had received voice therapy or previous laryngeal surgery. A questionnaire, laryngeal and perceptual evaluations, aerodynamic and acoustic parameters, and the Dysphonia Severity Index (DSI) were used to determine vocal characteristics., Results: In 74% of the subjects, flexible laryngeal videostroboscopic evaluation revealed a vocal pathology, with vocal nodules and muscle tension dysphonia as the most frequently diagnosed pathologies. Vocal abuse/misuse was present in 65% of the subjects. A median DSI value of -0.4 and -0.8 was found in female and male patients, respectively. Aerodynamic and acoustic parameters and DSI scores were significantly different from normative data., Conclusion: VF is a vocal sign with a significant need for medical consultation, especially in future professional voice users. Understanding the occurrence and the influencing variables of VF may help to close the gap between early stages of a vocal problem and the starting point of a well-established disorder., (© 2016 S. Karger AG, Basel.)

Objective: Since resonance disorders have a multidimensional nature and occur in several craniofacial pathologies, the aim of the present study was to determine the influence of age and gender in normal-speaking children without resonance disorders on an objective multiparametric index of hypernasality., Patients and Methods: A total of 74 Flemish children (37 boys and 37 girls), aged 4-12 years, without resonance disorders were included. A Nasometer was used to obtain nasalance scores (1 phoneme, 2 reading passages). An aerodynamic value was calculated using maximum duration time, and the mirror-fogging test by Glatzel was applied to visualize nasality as measured by condensation. With the obtained results, a 'Nasality Severity Index' (NSI) was calculated., Results: A significant age effect was found, in which the NSI increased with increasing age (p < 0.001). No significant difference for the NSI was detected concerning gender (p > 0.05). Unfortunately, considerable standard deviations from the mean NSI were found., Conclusion: Although a multiparametric index can form a more powerful approach in the assessment of and treatment planning for individuals with hypernasality, the present study revealed large interindividual differences in the current NSI. Therefore, adaptation of the current NSI is recommended, by which the influences of personal and environmental variables are taken into account., (© 2013 S. Karger AG, Basel.)

Objective: Because voice quality depends substantially on vocal fold closure (VFC), voice therapists try to modify VFC by specific voice techniques or adjustments in phonation mode. This study demonstrates the impact of six different phonation modes on VFC in healthy subjects., Methods: For this study, 21 female subjects with normal voice quality were selected. The impact of different phonation modes and voice techniques was examined by fiberoptic laryngovideoendoscopy during different modes of phonation: habitual phonation, high pitch, low pitch, resonance on /m/, Coblenzer's "abspannen," and chant talk. The video recordings were judged by three experienced professionals (two Speech and Language Pathologist and one laryngologist) by means of a visual analog scale., Results: Statistical analysis showed that only resonance on /m/ significantly improved VFC compared with habitual phonation. All other phonation modes and techniques, except low-pitched phonation, led to a significant worse closure in comparison with the closure at normal pitch. The glottic closure observed by low-pitched phonation was not significantly different than the closure at habitual pitch. Interrater agreement was moderate to very good, depending on the mode of phonation., Conclusions: The results of this study allow a better understanding of the impact of phonation mode and vocal therapy techniques on VFC in healthy subjects and give an indication about the impact of these methods to influence VFC., (Copyright © 2012 The Voice Foundation. Published by Mosby, Inc. All rights reserved.)

Objective: The purpose of this study is to determine objective vocal quality, vocal characteristics, and vocal habits in future speech language pathology (SLP) students and to evaluate the possible impact of a provided vocal counseling procedure. A comparison of vocal data was done in SLP students who had and who had not undergone vocal counseling procedure. It is hypothesized that counseling results in good vocal quality, adequate vocal performance, and appropriate vocal hygiene., Study Design: Randomized controlled study design., Methods: To determine the vocal quality, questionnaires (Voice Handicap Index [VHI]), subjective (videostroboscopic and perceptual evaluations), and instrumental assessment techniques (aerodynamic, vocal range, acoustic measurements, Dysphonia Severity Index [DSI]) were used. Identical voice assessments were made in 71 students who followed and have not (n=83) followed the vocal counseling procedure., Results: The VHI showed the absence of a psychosocial impact of the vocal quality. Thirty percentage of the subjects mentioned hoarseness as the most common vocal complain. Videostroboscopic evaluations revealed normal vocal anatomy and physiology. A significant difference regarding the DSI value was found between the students with (+3.3, 83%) and without (+1.8, 68%) a followed voice counseling procedure., Conclusion: This vocal counseling procedure is added as a standard procedure when future students gain information about the SLP master program. To what extent the presence and content of the vocal education strategy can influence the choice of the profession as an SLP is subject for further research., (Copyright © 2012 The Voice Foundation. Published by Mosby, Inc. All rights reserved.)

Aging influences the laryngeal anatomy and physiology, leading to altered vocal quality. In middle-aged women, the voice is affected by a combination of aging and menopausal transition. However, in many studies about vocal aging, the menopausal transition is not taken into account. The purpose of this study was to measure and describe the effect of aging on the vocal characteristics by comparing young women (between 20 and 28 years) and middle-aged premenopausal women (between 45 and 52 years). To determine the vocal characteristics in both groups, objective (aerodynamic measurements, vocal performance measurements, acoustic analysis, and a determination of the Dysphonia Severity Index) and subjective assessment techniques (perceptual evaluation, videostroboscopic evaluation, and Voice Handicap Index) were used. The middle-aged premenopausal women showed a smaller frequency and intensity range, a lower habitual fundamental frequency, and a higher soft phonation index compared with the young women. The results of this study are important when studying the voices of middle-aged women. Vocal characteristics of middle-aged women differ from young women, and these changes cannot only be because of hormonal changes during the menopause., (Copyright © 2011 The Voice Foundation. Published by Mosby, Inc. All rights reserved.)

The purpose of the present cross-sectional study was to determine the objective vocal quality and the vocal characteristics (vocal risk factors, vocal and corporal complaints) in 197 female students in speech-language pathology during the 4 years of study. The objective vocal quality was measured by means of the Dysphonia Severity Index (DSI). Perceptual voice assessment, the Voice Handicap Index (VHI), questionnaires addressing vocal risks, and vocal and corporal complaints during and/or after voice usage were performed. Speech-language pathology (SLP) students have a borderline vocal quality corresponding to a DSI% of 68. The analysis of variance revealed no significant change of the objective vocal quality between the first bachelor year and the master year. No psychosocial handicapping effect of the voice was observed by means of the VHI total, though there was an effect at the functional VHI level in addition to some vocal complaints. Ninety-three percent of the student SLPs reported the presence of corporal pain during and/or after speaking. In particular, sore throat and headache were mentioned as the prevalent corporal pain symptoms. A longitudinal study of the objective vocal quality of the same subjects during their career as an SLP might provide new insights., (2010 The Voice Foundation. Published by Mosby, Inc. All rights reserved.)

Objectives/hypothesis: The main purpose of this study was to determine the impact of thyroidectomy on the subjective and objective vocal quality using the Dysphonia Severity Index. It was hypothesized that objective measures of vocal function and other vocal characteristics would change (temporarily or permanently) from the presurgical to the postsurgical conditions, even with the entire preservation of the laryngeal nerve, due to the surgical approach and other influencing factors., Study Design: Prospective study in which 44 subjects were studied before (1 week) and three times post-thyroidectomy., Methods: Subjective (auditory perceptual evaluation and videolaryngostroboscopy) and objective (aerodynamic, vocal range, acoustic, and Dysphonia Severity Index measurements) assessment techniques were used., Results: Paired samples t test indicated a significant decrease of the highest frequency, the highest intensity, the fundamental frequency, and the Dysphonia Severity Index in the first postoperative condition. When a repeated measures analysis of variance was performed with the pre- and all the postoperative moments of evaluation taken into account, no significant difference was noted for any of the objective voice characteristics., Conclusions: After thyroidectomy subjects had a normal perceptual and objective vocal quality corresponding with a Dysphonia Severity Index of 66%, and there is no permanent change of the vocal performance. Moreover, there is no psychosocial handicapping effect of the vocal quality, but immediately post-thyroidectomy there are more vocal complaints. To what extent thyroidectomy causes (temporary or permanent) alterations of the singing voice in elite vocal performers is subject to further research.

Phonosurgery should lead to a better voice quality and a better quality of life. Only a few studies report outcome of phonosurgery in terms of stroboscopic, perceptual, aerodynamic, acoustic and self-rating data. The protocol as proposed by the European Laryngological Society (ELS; Dejonckere et al. in Arch Otorhinolaryngol 258:77-82, 2001) complies with this condition. A group of 47 patients who underwent phonosurgery was pre- and postoperatively assessed by means of the ELS protocol in order to evaluate postoperative outcome. Analysis of the data showed a significant improvement for all dimensions measured by stroboscopic parameters (glottic closure, mucosal wave, regularity and symmetry), perceptual voice quality (GRBAS), voice handicap index and the dysphonia severity index which represents both aerodynamic as acoustical measurements. In general, the significant improvement for a subgroup of exudative lesions of Reinke's space is more pronounced than for a subgroup with structural/congenital lesions.

There is a need for an objective measure that describes normal resonance and resonance disorders. The current standard of practice has not led to mismanagement but a refined objective assessment protocol will benefit a more precise objective assessment of velopharyngeal disorders. The purpose of the present study is to construct a nasality severity index (NSI) that reflects the multidimensional nature of resonance. Objective and subjective assessment techniques were used to determine the nasalance, the nasality and aerodynamic capacities in 21 children with cleft palate and a control group of 25 children without cleft palate. Stepwise logistic regression was used to determine the optimal index. The NSI consists of a linear combination of 4 variables, where each variable has a different weight. The equation is: NSI = -60.69 - (3.24 x percent oral text) - (13.39 x Glatzel value /a/) + [0.244 x maximum duration time (seconds)] - (0.558 x % /a/) + (3.38 x percent oronasal text). NSI sensitivity is 88% and specificity is 95%. Daily clinical use of the NSI has shown it to be an efficient and practical tool to describe the presence of hypernasality. Three distinct follow-up cases are presented to illustrate the impact of a surgical technique, the use of a speech bulb and velopharyngeal biofeedback training on NSI. The implementation of the NSI may help clinicians to quantitatively assess the severity of nasality disorders beside the perceptual judgments.

The goal of this study is to analyze and evaluate the effectiveness of a voice-training program. Twenty-three professional voice users received voice training for 2 years and vocal hygiene education for 1 year. The voice-training program consisted of lectures, technical workshops, and vocal coaching. The European Laryngological Society (ELS) protocol, including the Dysphonia Severity Index (DSI) and the Voice Handicap Index (VHI), was applied before and after, respectively, 9 and 18 months of voice training. A questionnaire on daily habits was presented at study onset and after 18 months. The DSI improvement is more significant after 9 months (P=0.005) than it is after 18 months (P=0.2). On the other hand, the perceptual evaluation remained unchanged after 9 months, whereas it improved significantly after 18 months. The results of the daily habit questionnaire are disturbing: the prevalence of smoking, vocal abuse, stress, and late meals were not influenced by the lectures and remained high. This study emphasizes the need for a well-organized voice-training program that is most effective after 9 months. Regarding the low effectiveness of the vocal hygiene program, the concept needs revision.

The goal of this study is to define the long-term influence of vocal hygiene education and the effectiveness of voice training in 46 students. Half of the subjects, called the trained group (n = 23), received vocal hygiene education during 1 school year and voice training during 2 school years (18 months). The other half, also 23 subjects, received neither vocal hygiene education nor voice training as such (called the untrained group). The voice training is made up of technical workshops (30 h a year in groups of 5-8 subjects) and vocal coaching in the radio and drama projects (30 h whole class). In the lectures (30 h) a theoretical background on breathing, articulation, voicing and vocal hygiene was discussed. A multidimensional test battery containing the GRBAS scale, videolaryngostroboscopy, maximum phonation time, jitter, lowest intensity, highest frequency, Dysphonia Severity Index (DSI) and Voice Handicap Index (VHI) was applied before and after 18 months to evaluate the effect of voice training over time. A questionnaire on daily habits was presented before the lectures, and after 18 months to detect the long-term effect of the lectures. The objectively measured voice quality (DSI) of the trained group improved significantly over time (p < 0.001) due to training (p = 0.008), which was not the case in the untrained group. The self-assessed VHI, on the other hand, changed over time (p < 0.001) in both groups. For the trained group the VHI changed from 18.4 to 14.4 and in the untrained group from 20.1 to 15.3. It is important to note that the VHI scores of both groups remained high. The interpretation of the results of the daily habit questionnaire is disturbing: the initial high degree of smoking, vocal abuse, stress and late meals was not influenced by the lectures or training and remained high. This study proves the positive outcome and emphasizes the need for a well-organized voice training program in future professional voice users. However, the lectures and training on vocal hygiene failed to improve voice-conserving habits., (Copyright 2004 S. Karger AG, Basel)

In this study, the effect of age, sex, and disorder on the vocal performance of 230 children 6 to 11 years of age was investigated by means of the voice range profile (VRP). Ninety-four control children and 136 children with disorders were studied. The VRPs were quantitatively described by frequency and intensity characteristics, as well as by morphological characteristics. Significant differences between healthy children and children with disorders were found. Age has a different effect in girls than in boys regarding vocal performance. Most of the characteristics for the healthy girls change gradually over the period from 6 to 11 years. For the healthy boys, however, two age groups can be identified: one below and one above 8 years of age. It is hypothesized that the androgen dehydroepiandrosterone (DHEA) and its sulfate may play a role in this phenomenon.

The main purpose of the present acoustical study was to delineate further the changes in nasal resonance in childhood and young adulthood. An additional objective was to collect reference nasal resonance scores for normal Flemish-speaking children. Scores were recorded with a Nasometer while 33 children produced sounds and read three standard passages. We compared the nasal resonance data from the children with those of 58 adults that had been obtained in a previous study. Age had a significant effect on three sounds and two texts. The results indicated that young Flemish adults had higher nasal resonance scores than children, particularly when the reading stimuli included nasal consonants for which a co-ordinated opening and closing function of the velopharyngeal mechanism was required. These results reflect anatomical changes and differences in speech programming associated with growth.

Normative voice range profiles (VRPs) are calculated for a group of untrained boys and girls between 6 and 11 years based on 35 and 39 recordings, respectively. All individuals had healthy voices. These normative VRPs contain 95% prediction intervals (PI) for both frequency and intensity. They are based on a series of mathematical transformations of the original individual VRPs in order to maintain in the normative VRPs the typical oval VRP shape including the dip between modal and falsetto register. The presented normative VRPs are directly applicable in the clinical practice of otolaryngologists and speech-language pathologists.

Various rating scales have been used for perceptual voice analysis including ordinal (ORD) scales and visual analog (VA) scales. The purpose of this study was to determine the most suitable scale for studies using perceptual voice analysis as a gold standard for validation of objective analysis protocols. The study was carried out on 74 female voice samples from 68 dysphonic patients and 6 controls. A panel of 4 raters with experience in perceptual analysis was asked to score voices according to the G component (overall quality) of the GRBAS system. Two rating scales were used. The first was a conventional 4-point ORD scale. The second was a modified VA (mVA) scale obtained by transforming the VA scale into an ORD scale using a weighted conversion scheme. Objective voice evaluation was performed using the EVA workstation. Objective measurements included acoustic, aerodynamic, and physiologic parameters as well as parameters based on nonlinear mathematics (e.g., Lyapunov coefficient). Instrumental measurements were compared with results of perceptual analysis using either the conventional ORD scale or mVA scale. Results demonstrate that correlation between perceptual and objective voice judgments is better using a mVA scale than a conventional ORD scale (concordance, 88 vs. 64%). Data also indicate that the mVA scale described herein improves the correlation between objective and perceptual voice analysis., (Copyright 2002 S. Karger AG, Basel)

The voice quality of 86 occupational voice users, i.e., students of a high school for audiovisual communication, was assessed by means of a multidimensional test battery containing: the GRBAS scale, videolaryngostroboscopy, maximum phonation time, jitter, lowest intensity, highest frequency, dysphonia severity index (DSI), and voice handicap index (VHI). In a questionnaire on daily habits the prevalence of smoking, eating habits, and vocal abuse were recorded. A comparison of the voice characteristics of the future occupational voice users with a control group revealed significant differences. The results of the VHI and the DSI of these students revealed significantly worse scores than the score of a control group characterized by no vocal complaints. Moreover, the questionnaire on daily habits showed that the future elite vocal performers and professional voice users take less precautions for the care of their voices. These findings support the importance of a good balanced vocal coaching.

The main purpose of this study was to measure and compare the effect of an unilateral cleft lip and palate (UCLP) and a bilateral cleft lip and palate (BCLP) on overall speech intelligibility, nasalance and nasality. An additional objective was to compare the nasalance and nasality patterns of cleft palate children with the available normative data for normal children. The subjects were 37 children with an UCLP (19/37) or a BCLP (18/37) with normal cognitive and motor functions and normal hearing levels. All subjects had a non-syndromic cleft, followed the same surgical protocol and did not undergo secondary pharyngeal surgery. To measure and compare the effect of cleft type, objective and subjective assessment techniques were used. For the objective assessment of nasal resonance the nasometer and the mirror-fogging test were used. Nasalance scores were obtained, while patients produced sounds, read three standard passages or repeated sentences focusing on specific consonants. A perceptual evaluation of speech, the Gutzmann (1913) test and the tests of Bzoch (1989) were used as subjective assessment techniques. The perceptual assessment of the overall speech intelligibility was based on the spontaneous speech and reading or repeating of the nasometric sentences. These samples were judged by three speech pathologists using a 4-category nominal scale. A subjective test (Morley, 1945) was used to evaluate the velopharyngeal mechanism. The findings of the present study show no statistically significant differences for nasalance values, nasality and overall speech intelligibility between the UCLP and BCLP children. Significant differences were found between the data of the normal group and the cleft palate children. These differences included nasalance values as well as nasality data and overall speech intelligibility., (Copyright 2002 S. Karger AG, Basel)

Normative voice range profiles (VRP) are calculated for a group of male and female teachers, based on 43 and 46 recordings, respectively. All individuals had healthy voices. These normative VRPs contain 95% prediction intervals for both frequency and intensity. They are based on a series of mathematical transformations of the original individual VRPs in order to maintain in the normative VRPs the typical oval VRP shape, including the dip between modal and falsetto register. The normative VRPs presented are directly applicable in the clinical practice of otolaryngologists and speech-language pathologists.

The vocal quality of a patient is modeled by means of a Dysphonia Severity Index (DSI), which is designed to establish an objective and quantitative correlate of the perceived vocal quality. The DSI is based on the weighted combination of the following selected set of voice measurements: highest frequency (F(0)-High in Hz), lowest intensity (I-Low in dB), maximum phonation time (MPT in s), and jitter (%). The DSI is derived from a multivariate analysis of 387 subjects with the goal of describing, purely based on objective measures, the perceived voice quality. It is constructed as DSI = 0.13 x MPT + 0.0053 x F(0)-High - 0.26 x I-Low - 1.18 x Jitter (%) + 12.4. The DSI for perceptually normal voices equals +5 and for severely dysphonic voices -5. The more negative the patient's index, the worse is his or her vocal quality. As such, the DSI is especially useful to evaluate therapeutic evolution of dysphonic patients. Additionally, there is a high correlation between the DSI and the Voice Handicap Index score.

Objectives: Investigate whether vocal problems in future professional activities can be predicted by early laryngeal and phoniatric evaluation and whether a vocal endurance test can contribute to this evaluation., Study Design: Five-year follow-up study of 30 female education majors, initially documented with a standard voice assessment and a vocal endurance test. Measurements before and after vocal endurance testing were compared and related to the vocal outcome 5 years after the initial testing., Methods: Voice assessment included perceptual evaluation, airflow measurements, Fo and SPL measurements, voice range profile and laryngeal (stroboscopic) examination. The Standard Tolerance Test, as recommended by the Union of European Phoniatricians, was followed. This data set was completed with a questionnaire concerning the subjects' vocal behavior. This questionnaire was repeated 5 years later., Results: No significant differences were found for ENT scores (laryngostroboscopy) (P = .018). Logistic regression was used to determine a relationship between initial observations and the final outcome., Conclusions: The role of an endurance test as used in this study is negligible for the prediction of vocal outcome. A combination of laryngeal examination, maximum phonation time, and perceptual evaluation, assessed prior to the endurance test, reveals a prediction of the vocal outcome with a specificity of 90% and a sensitivity of 70%.

The present prospective study, based on a series of 12 male patients managed with supracricoid partial laryngectomy with cricohyoidoepiglottopexy (SCPL-CHEP), was designed i) to compare the perceptual and acoustic parameters before surgery and at 6 months after sugery, ii) to evaluate the evolution of the perceptual and acoustic parameters between 6 and 18 months postoperatively, and iii) to determine the correlations between the perceptual and acoustic parameters preoperatively and at 18 months postoperatively. The roughness was found to be significantly worsened after SCPL-CHEP. The jitter, shimmer, noise-to-harmonic ratio, and degree of voiceless increased significantly after SCPL-CHEP. Neither acoustic nor perceptual parameters varied significantly between 6 and 18 months postoperatively. Preoperatively, a strong statistical correlation was found between grade, roughness and strain and all acoustic parameters but F0. Breathiness was statistically correlated with all acoustic parameters but jitter. Postoperatively the only statistical correlation noted was between roughness and F0.

Voice range profiles (VRPs) were analyzed according to 11 frequency, intensity, and morphological characteristics for 94 normal children and 136 children with vocal fold pathologies (ages 6-11 years). Normative data are presented showing marked differences between the groups. Using a specific combination of the child's age, the highest vocal fundamental frequency, the lowest intensity, and the slope of the upper VRP contour, a Voice Range Profile Index for Children (VRPIc) may be constructed using discriminant analysis. It is shown how the VRPIc can be used to screen children for vocal disorder or to quantitatively assess the effectiveness of voice treatment. Since the group means of the VRPIc for healthy and dysphonic children are scaled to +10 and -10, respectively, the VRPIc enables the clinician to rate a child's vocal performance with reference to healthy and dysphonic children in general. The sensitivity and specificity of this method was found to be 90% and 83%, respectively.

Perceptual evaluation was performed by means of the GRBAS scale for a series of nine pathological voice samples that were presented twice to a group of 23 judges, consisting of experienced and inexperienced otolaryngologists (ENTs) and speech-language pathologists (S/LPs). The time interval between ratings was 14 days. Test-retest reliability was moderate. The best agreement between the observers was obtained for the G (grade) parameter and the worst for the S (strained) parameter. Considering the medians of the GRBAS ratings, no significant influence was measured for level of experience or professional background. Yet, based on means, the results show that professional background has a greater impact on perceptual rating than experience.

The consent about the necessity of perceptual evaluation in the assessment of patients with voice disorders is almost unanimous. This is not the case with regard to the method or scale. This article gives an outline of historical backgrounds and presents a survey of contemporary perceptual rating scales. Reliability and influencing factors are discussed and recommendations are made with respect to clinical use.