Rating scales are commonly used to study voice quality. The purpose of this study was to examine inter-rater reliability/agreement of graduate student clinicians with differing levels of experience in rating voice perception. The Consensus Auditory Perception Evaluation of Voice (CAPE-V) was used to asses 1.) overall severity, 2.) roughness, 3.) breathiness, 4.) strain, 5.) pitch and 6.) loudness from a sample of pediatric voices. Twenty-four graduate clinicians who had completed a graduate level course in voice disorders participated in the study. Twelve of the participants were randomly selected to complete a perceptual training course prior to the evaluation session. Voice samples included 10 disordered and 2 normal voices from a population of children age 3-10 years old. The 12 voice samples were randomly repeated 3 times. Results of analysis of variance indicated that the groups significantly differed in their severity rating of the perceptual indices, suggesting that training affected the participants' judgment of severity. Additionally, variability was reduced as a function of training. Pearson product-moment correlation coefficient's revealed a moderate to strong relationship for all of the perceptual indices suggesting that regardless of training participants have an implicit understanding of normal versus disordered voice samples.

Made available in DSpace on 2016-04-27T18:11:57Z (GMT). No. of bitstreams: 1 Ana Carolina de Assis Moura Ghirardi.pdf: 1345817 bytes, checksum: bdd2edd16052f1795c01817766f2e654 (MD5) Previous issue date: 2012-10-24 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The voice is the main work tool for teachers. Correct identification of a disorder through eficiente methods of assessment and screening will contribute to planning actions and devising specific public policies for this population. Aim: to analyze the different methods of identification and assessment and to propose a screening instrument for voice disorders in teachers. Method: The subjetcs of the study are 252 female teachers of the public school system of São Paulo, who had their voices recorded and analyzed by three speech-language pathologists using the GRBASI scale to classify their voice qualities (with or without disorder). In the same day of voice recording, subjects underwent vocal fold examinations, and the responsible doctor classified the images (with or without disorder). The teachers also answered questions in the Vocal Aspects Domain of the Teacher Voice Production Conditions questionnaire (CPVP) and the Voice Handicap Index (VHI). The data were submitted to statistical analysis, conducted with two purposes: 1) to verify the agreement between voice perceptive-auditory and vocal fold assessment, and 2) to devise and validate a screening instrument for voice disorders in teachers. In order to study the agreement in between both assessments, Kappa s correlation coefficient was calculated with level of significance at p &#8804;0.05. To devise the screening instrument, the data of 130 teachers (sample A) with and without voice disorder were used. An exploratory factorial analysis was conducted from the list of 21 symptoms originally in the Vocal Aspects domain of the CPV-P, and the items with correlation coefficient greater than 0.50 were chosen. A ROC curve was plotted in order to identify the best cut-off point to select teachers who may have a voice disorder and Cronbach s alpha coefficient (&#945;) was calculated in order to assess the score- s internal consistency. The external validation of the instrument was conducted using the data of the 122 remaining subjects (Sample B). Each teacher s score was calculated and the internal consistency of the data was analyzed using Cronbach s alpha coefficient (&#945;). Next, the mean scores and 95% confidence intervals were calculated. The association between the scores and assessment using GRBASI scale was calculated using the chi-square test (p&#8804;0,05), and concurrent validity was analyzed calculating Spearman s correlation coefficient (r) between the score of the proposed instrument and VHI results. Results: The gross agreement between voice quality and vocal fold assessment was 77.9, and Kappa agreement index between both assessments was k = 0.40 (p < 0.001). The 12 symptoms selected by the factorial analysis to compose the Screening Index for Voice Disorder (SIVD) were: hoarseness, voice loss, breaking voice, low-pitched voice, phlegm, dry cough, cough with secretion, pain when speaking, pain when swallowing, secretion in throat, dry throat and strained speech. Chronbach s alpha coefficient for Sample A was &#945; = 0,86. The score was defined as the simple sum of the number of present symptoms and the cut-off was five points. Chronbach s alpha coefficient for sample B was &#945; = 0.89. For this sample, the instrument s sensitivity with cut-off=5 was 92% and specificity 39%. There was a statistically significant association (p &#8804;0.001) between the SIVD score and voice quality assessment using the GRBASI scale. There was also statistically significant correlation (p &#8804;0.001) between the total VHI score and SIVD score, and the same was true for each VHI domain and SIVD score. Final Remarks: The association of perceptive-auditory vocal assessment and vocal fold evaluation should be considered the gold-pattern in voice disorder diagnosis. The SIVD is a valid instrument for screening with a high sensitivity level. Therefore, its use will aid in mapping voice disorders, and in planning public health actions and devising public policies regarding teachers / Professores têm na voz a sua principal ferramenta de trabalho. A correta identificação de um distúrbio por meio de métodos eficientes de avaliação e triagem contribuirá para o planejamento de ações e delineamento de políticas públicas específicas para essa população. Objetivo: analisar os diferentes métodos de identificação e avaliação do distúrbio de voz e propor um instrumento para triagem desse distúrbio em professores. Método: Os sujeitos deste estudo são 252 professoras da rede municipal de São Paulo, que tiveram suas vozes gravadas, e posteriormente analisadas por três fonoaudiólogas, que utilizaram a escala GRBASI para classificar a qualidade vocal dos sujeitos (com ou sem alteração). No mesmo dia da gravação os sujeitos realizaram exame perceptivo-visual das pregas vocais, e o médico otorrinolaringologista responsável classificou as imagens (com e sem alteração). As professoras responderam também às questões relativas ao domínio de Aspectos Vocais do questionário Condição de Produção Vocal do Professor (CPV-P), e ao Índice de Desvantagem Vocal (IDV). Os dados foram duplamente digitados e submetidos a análise estatística, realizada com dois objetivos: 1) - verificar a concordância entre a avaliação perceptivo-auditiva da voz e de pregas vocais apenas nas professoras com queixa vocal, e 2) desenvolver e validar um instrumento de triagem para o distúrbio de voz em professores. A fim de se estudar a concordância entre as duas formas de avaliação, foi calculado o coeficiente de correlação Kappa (k), com nível de significância p &#8804;0.05. Para desenvolver o instrumento de triagem foram utilizados os dados de 130 professoras (Amostra A) com e sem distúrbio de voz. Realizou-se uma análise fatorial exploratória a partir da lista de 21 sintomas vocais que compõem o domínio de Aspectos Vocais do CPV-P, e foram selecionados os itens que obtiveram coeficiente de correlação maior do que 0.50. Traçou-se uma curva ROC a fim de identificar o melhor ponto de corte para seleção de professoras que poderiam ter um distúrbio de voz, e calculou-se o coeficiente alfa de Cronbach (&#945;) para avaliar a consistência interna do escore. A validação externa do instrumento foi realizada a partir dos dados dos 122 sujeitos restantes (Amostra B). O escore de cada sujeito foi calculado, e a consistência interna dos dados foi analisada por meio do coeficiente alfa de Cronbach (&#945;). A seguir, foram calculados os escores médios e Intervalos de Confiança de 95%. A associação entre os escores obtidos e o resultado da avaliação pela escala GRBASI foi calculada por meio do teste do quiquadrado (p&#8804;0,05), e a validade concorrente foi analisada por meio do cálculo do coeficiente de correlação de Spearman (r) entre o escore do instrumento proposto e os resultados do IDV. Resultados: A concordância bruta entre a avaliação da voz e avaliação das pregas vocais foi 77,9, e o índice de concordância Kappa entre as duas avaliações foi k = 0,40 (p < 0,001). Os 12 sintomas selecionados pela análise fatorial para compor o índice de triagem para distúrbio de voz (ITDV) foram: rouquidão, perda da voz, falha na voz, voz grossa, pigarro, tosse seca, tosse com secreção, dor ao falar, dor ao engolir, catarro na garganta, garganta seca, e cansaço ao falar. O coeficiente alfa de Cronbach para a amostra A foi &#945; = 0,86. O escore foi definido como a somatória simples do número de sintomas presentes e o ponto de corte estabelecido foi de cinco pontos. O coeficiente alfa de Cronbach para a amostra B foi &#945; = 0,89. Para essa amostra, a sensibilidade do instrumento com o ponto de corte = 5 foi 92% e especificidade 39%. Foi encontrada associação estatisticamente significativa (p &#8804;0,001) entre o escore no ITDV e a avaliação da qualidade vocal realizada por meio da escala GRBASI. Também houve correlação estatisticamente significativa (p &#8804;0,001) entre o escore total do IDV e a pontuação no ITDV e o mesmo também ocorreu quando comparados cada domínio do IDV e o escore do ITDV. Considerações Finais: A associação entre avaliação perceptivo-auditiva da voz e avaliação de pregas vocais deve ser considerada padrão ouro no diagnóstico de distúrbio de voz. O ITDV é um instrumento válido para triagem e possui alto grau de sensibilidade. Assim, seu uso deve auxiliar no mapeamento do distúrbio de voz do professor, bem como no planejamento de ações de saúde pública e delineamento de políticas públicas referentes à saúde vocal dessa categoria profissional

Vid användning av audio-perceptuell röstanalys för framtagning av referensröster är begreppet reliabilitet av central betydelse. Syftet med denna uppsats var att undersöka reliabiliteten mellan erfarna röstlogopeders perceptuella röstanalys av ett antal utvalda röstexempel. Förhoppningen var att utifrån detta kunna sammanställa en början till ett referensröstmaterial bestående av manliga och kvinnliga referensröster representativa för olika parametrar i SVEA-protokollet. De specifika frågeställningarna var: Hur samstämmiga i perceptuell röstanalys är bedömarna kring de valda röstexemplens olika parametrar? Är någon eller några av de parametrar som bedömarna är överens om extra framträdande i någon röst så att denna röst kan användas som referensröst? Utifrån en databas med 65 röstinspelningar valdes 15 röstexempel ut av författarna att skattas av sju erfarna logopeder med SVEA-protokollet. En andra bedömningsomgång genomfördes med tre röstexempel slumpvis utvalda från de 15 röstexemplen i den första bedömningsomgången. Statistiska analyser av logopedernas inter- och intrabedömarreliabilitet gjordes både på alla röstexempel och på samtliga kvalitetsparametrar. Bedömarnas skattningar uppvisade mycket stor spridning i flera röstexempel, vilket inverkade på korrelationernas utfall och kan vid en första anblick ge ett missvisande resultat. En djupare analys av bedömarnas skattningar av enskilda röstparametrar visade på betydligt högre samstämmighet. Utifrån detta resultat tog författarna fram tre potentiella referensröster. Flera av de övriga 12 röstexemplen hade relativt hög interbedömarreliabilitet men då skattningsvärdena var så pass låga för dessa röster valdes de inte ut som referensröster. Trots låga skattningsvärden skulle dessa röstexempel kunna användas som referensröster för att exemplifiera lägre grader av avvikelser. Slutsatsen är att det finns skillnader i hur bedömarna skattat röstexemplen i denna studie och reliabiliteten mellan bedömarna skiftar. Författarna drar även slutsatsen att det är motiverat att fortsätta leta och analysera röstexempel för att få en heltäckande uppsättning referensröster. Metodvalet i denna studie anses vara en framkomlig väg för att fortsätta forma detta referensröstmaterial. / Interrater and intrarater reliability are of great importance in the selection of reference voice examples. The purpose of this study is to investigate the reliability of experienced speech and language pathologists’ evaluations of selected voice samples. The aim is to begin a collection of male and female reference voice examples which represent different voice quality parameters according to the Stockholm Voice Evaluation Approach (SVEA). The specific questions are: How well do speech and language pathologists agree when rating voices along different voice quality parameters? Are any of the voice quality parameters in the speech samples prominent enough to be qualified as reference voice examples? The authors selected 15 voice samples out of a database consisting of 65 voice samples. The voices were evaluated by seven experienced speech and language pathologists using the SVEA protocol. The results were statistically analyzed to study interrater reliability. In order to investigate intrarater reliability a second evaluation session was carried out in which the speech and language pathologists evaluated three voice samples randomly selected from the 15 samples used in the first evaluation session. The results showed a wide range in the raters’ evaluations, which had an impact on the correlations. However, a closer look at separate parameters indicated considerably higher similarity in the ratings. Based on these results three reference voice examples were selected. Even though high correlation values were found in several of the other twelve voice samples, the ratings in these were not high enough to qualify them as reference voice examples in this study. Nevertheless, these voices can still be used to exemplify various degrees of deviation. The conclusions are that there is a great variation regarding reliability between and within raters and also regarding how the different speech and language pathologists rate the voices. The authors also conclude that the search for clear reference voice examples is highly motivated and ought to be continued, preferably with the method used in this study.

Background Previous research has emphasized the importance of objectivity in voice quality evaluation. Acoustic voice quality index (AVQI) is a multiparametric objective index, that quantifies overall voice quality. Over the past decade, international studies have demonstrated strong diagnostic accuracy and sensitivity of AVQI to voice disorders. Ithas yet been inconclusive whether AVQI is independent of factors such as age and gender or if AVQI is affected by different types of continuous speech segments.  Aim  The aim of this study is to gather descriptive data regarding AVQI’s performance in a healthy Swedish-speaking population. Another objective is to investigate the potential impact of varying characteristics, such as age and gender, and type of continuous speech samples on the AVQI values.  Method  The present study gathered speech samples from 137 participants aged 20 to 90 years with a balanced gender distribution. These samples contained two different types of continuous speech, from which separate AVQI valuesin the acoustic analysis were computed. An analysis of covariance (ANCOVA) was then used to study the effects of age, gender, and type of continuous speech used on the resulting AVQI values.  Results  Descriptive normative data was gathered for the overall voice quality of the age groups included in this study. A statistically significant main effect of age on the AVQI values was observed. Statistical analysis revealed no significant effect of speech type, speaker gender or the interaction of age and gender on the AVQI values.   Conclusions  In conclusion, the present study offered data for AVQI values in the Swedish-speaking population. AVQI scores were higher in older participants compared to the younger participants. No other significant effects were found in this study. AVQI values obtained in this study and comparisons carried out with international AVQI values indicatepotentially successful use of the acoustic voice quality index in the Swedish-speaking population with some precautions.