• Journal of Pharmacopuncture
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• v.17 no.3
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• pp.57-61
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• 2014

Objectives: When a person speaks, voice problems usually include pain or discomfort and/or difficulties in terms of the pitch, the loudness and the quality of the voice. When patients with voice problems induced by stroke, Parkinson's disease, and systemic diseases involving the voice are examined, generally, of the Four Diagnoses (四診), a Diagnosis of Hearing can be used in current Korean medicine. The effects of acupuncture and herb medicine on voice problems have been reported for over 20 years. However, when it comes to improvements, objective and subjective evaluation methods need to be explained. Methods: Subjective methods for evaluating voice were studied through a literature search of old medicinal books containing Korean medicine diagnostics, and an objective evaluation method using Praat software is presented. Results: Korean medicine doctors analyze the patient's voice in clinical settings unconsciously on a daily basis. However, most voice diagnoses depend on the doctor's subjective evaluation. Voice qualities can be evaluated by using the Eight Principles (八綱), including Yin-Yang; the Five Elements (Phases); the Grade, Roughness, Breathy, Asthenic, Strained (GRBAS) score, and the Visual Analogue Scale (VAS) as subjective methods, and an acoustic analysis using the Praat program can be used as an objective method. Conclusion: A more complete voice examination can be achieved by using subjective and objective methods at the same time. For an objective explanation and management of patient's voice problems or systemic disorders, an objective method should be used in Korean medicine, which already has many subjective diagnostic methods. More research needs to be conducted, and more clinical evidence needs to be collected in the future.

• Phonetics and Speech Sciences
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• v.3 no.3
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• pp.167-172
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• 2011

The purpose of this study was to examine the relationship between subjective and objective evaluation in speakers with voice disorders. Subjective evaluation indicates the self-reports of voice problems by dysphonic speakers. The relating protocol is the Voice Handicap Index (VHI) and the self-awareness index of voice problems (SAIVP-14). A total of 48 individuals with voice disorders replied to the questionnaire and participated in a voice assessment. Objective evaluations included the perceptual judgement of G grade in GRBAS, acoustic measurements (jitter, shimmer, NHR) by MDVP (CSL 4400), and aerodynamic measurements (MPT, MFR, psub) by PAS (Phonatory Aerodynamic System, KayPentax, USA). Pearson and Spearman correlations were used for the analysis. In the correlation with perceptual judgement (G grade) and VHI-Total, VHI-Physical, and SAIVP-14, there was a significant correlation, but the overall correlation was poor. NHR, jitter, and shimmer were significantly correlated with overall VHI and SAIVP-14. Specifically, the correlation with shimmer was stronger compared to the other measurements. In aerodynamic measures, MFR and MPT showed a significant correlation with VHI-Total, VHI-Emotional, and SAIVP-14, but their correlation was poor. The results of this study suggested that subjective evaluation of self voice problems is meaningfully correlated with objective evaluations, but more data in the multidimensional voice assessment should be collected and analyzed for the reliability and validity of the voice handicap questionnaire.

• Speech Sciences
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• v.10 no.4
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• pp.201-219
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• 2003

Background: The perceptual assessment is generally performed by the voice specialist. The objective evaluation is performed in a voice laboratory. Research in voice laboratories has generated a variety of different objective tests and parameters. The perceptual evaluation is one of the most controversial topics in voice research. Review of literature reveals a wide variety of rating scales and reliability data fluctuating from study to study. Unfortunately, there is no widely accepted valid method for classifying voice disorders and assessing outcome after voice treatment. Objectives: The goals of this research were to identify important objective acoustic parameters of vocal quality, and to establish an objective and quantitative correlate of the perceived vocal quality. Materials and Methods : We evaluated the voice analyzed data from 122 dysphonic patients and 20 normal volunteers. A computerized speech lab. 4300B(CSL) was used to carry out the analysis of each voice sample. Results: Three dysphonia severity indices(DSI) were created using discriminant analysis. DSI is based on the weighted combination of the following selected set of acoustic parameters: absolute jitter(Jita in us), smoothed pitch period perturbation (sPPQ in %), amplitude perturbation quotient(APQ in %), soft phonation index(SPI), average fundamental frequency(Fo in Hz), lowest fundamental frequency(Flo in Hz), and smoothed amplitude perturbation quotient(sAPQ in %). The DSI, being the discriminating rule calculated by the logistic regression, consists of three equation based on statistically significant acoustic parameters. Three DSI were created to reflects best the degree of hoarseness as expressed by G from the GRBAS scale. The more positive this DSI is for a patient, the worse the vocal quality. The more it is negative, the better it is. The effect of sex is included implicitly in the DSI-1 and DSI-2, so that a separate DSI-1 and DSI-2 for males and females need not be used. The DSI is objective because no perceptual input is required for its calculation. Conculsion : This research demonstrates that the voice function values calculated from three different multivariate objective dysphonia severity indices are significantly associated with subjective voice assessments. These multivariate objective dysphonia severity indices may be appropriate for use in clinical trials and outcomes research on treatment effectiveness for voice disorders.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.19 no.2
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• pp.89-95
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• 2008

Subjective voice evaluation is necessary and important to assess the voice disorders in addition to objective voice evaluation. Subjective voice evaluation is divided into examiner and examinee subjective voice assessment. The examiner assessment represents perceptual judgment to the patient's voice such as GRBAS scale, Buffalo voice profile, consensus auditory perceptual evaluation of voice (CAPE- V) and so on. The examinee assessment consists of indirect method including voice handicap index (VHI), voice outcome survey (VOS), voice symptom scale (VoiSS), voice related quality of life (V-ROQL) and direct method which is called patient's self-subjective voice rating. This review article describes a general rule, advantages and pitfalls about GRBAS scale, VHI and patient's self-subjective voice rating which are presently most representative voice assessment tools.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.32 no.2
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• pp.75-80
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• 2021

Background and Objectives Functional aphonia refers to in which by presenting whispering voice and almost producing very high-pitched tensed voices are produced. Voice therapy is the most effective treatment, but there is a lack of consensus for application of voice therapy. The purpose of this study was to examine the vocal characteristics of functional aphonia and the effect of voice therapy applied accordingly. Materials and Method From October 2019 to December 2020, 11 patients with functional aphonia were treated using voice therapy which was processing three stages such as vocal hygiene, trial therapy, and behavioral therapy. Of these, 7 patients who completed the voice evaluation before and after voice therapy was enrolled in this study. By retrospective chart review, clinical information such as sex, age, symptoms, duration, social and medical history, process of voice therapy, subjective and objective findings were analyzed. Voice parameters before and after voice therapy were compared. Results In GRBAS study, grade, rough, and asthenic, and in Consensus Auditory-Perceptual Evaluation of Voice, overall severity, roughness, pitch, and loudness were significantly improved after voice therapy. In Voice handicap index, all of the scores of total and sub-categories were significantly decreased. In objective voice analysis, jitter, cepstral peak prominence, and maximum phonation time were significantly improved. Conclusion The voice therapy was effective for the treatment of functional aphonia by restoring patient's vocalization and improving voice quality, pitch and loudness.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.9 no.1
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• pp.32-37
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• 1998

Tonsillectomy is the one of operation that is performed the most commonly in otolaryngology field. Many changes that include range of voice, tone, voice quality and resonance were made by tonsillectomy. Sometimes, any patients taken tonsillectomy has suffer from these voice problem after tonsillectomy. However there are less study for these problems until now. Then, we studied to find the anatomical findings that affected the voice quality when tonsillectomy was performed. We evaluated the voice in 2 groups, one is the group showed the normal pharyngeal space by using the transnasal fiberscopy, the other is group showed medially bulging tonsil at pharyngeal cavity by using same method, with perceptual evaluation, nasalance score, nasality, oral formant and nasal formant. We used the computerized speech analysis system, the nasometer and the spectrogram in the CSL program. We could not find any differences in perceptual evaluation between two groups. But objective measures were provided. Nasalance score and nasality on the nasometric analysis were increased significantly and oral formant on the spectrogram was changed singnificantly after tonsillectomy in Group 2. Authors thought medially bulging tonsil in the pharynx is able to affect the voice quality after tonsillectomy when we evaluted through the nasal cavity by the using of fiberscopy and this evaluation would be important especially in singers.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.30 no.2
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• pp.118-123
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• 2019

Background and Objectives Voice evaluation is classified into subjective tests such as auditory perception and self-measurement, and objective tests such as acoustic and aerodynamic analysis. When evaluating dysphonia, subjective and objective test results do not always match. The purpose of this study was to analyze the relationship between subjective and objective evaluation in patients with dysphonia and to identify meaningful parameters by disease. Materials and Method The total of 322 patients who visited voice clinic from May 2017 to May 2018 were included in this study. Laryngeal lesions were identified using stroboscopy. Pearson correlation test was performed to analyse correlation between subjective tests including GRBAS scale and voice handicap index, and objective tests including jitter, shimmer, noise to harmonic ratio (NHR), cepstral peak prominence (CPP), maximal phonation time (MPT), mean flow rate, and subglottic pressure. Results In vocal nodule and sulcus vocalis, among GRBAS system, grade and breathiness showed good correlation with CPP, and roughness showed good correlation with jitter or shimmer. In unilateral vocal cord paralysis (UVCP), grade and breathiness showed a very good correlation with CPP, and also good correlation with jitter, shimmer, NHR, and MPT. Also asthenia showed good correlation with CPP and MPT. Vocal polyp has a limited association with other diseases. Conclusion In patients with dysphonia, grade and breathiness showed good correlation with CPP, jitter, and shimmer, and reflect the state of voice change well especially in UVCP, CPP, and MPT.

• Proceedings of the KSPS conference
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• 2007.05a
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• pp.292-294
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• 2007

This study was designed to compare the translated patient's subjective rating scales for voice evaluation (Voice Handicap Index; VHI, Voice-Related Quality of Life; V-RQOL, Voice Rating Score; VRS) into Korean, taken from 24 professional voice users diagnosed with organic voice disorders. First, the correlation amongh those scales were observed. Second, the correlation between the patient's subjective rating scales and acoustic measures (Jitter%, Shimmer%, NHR) were examined. Third, those scales were compared by clinician's objective scale (G in GRBAS scale). Results indicated that significant correlations among the patients' subjective rating scales and significant correlations of clinician's rating scale with jitter% and Shimmer%, but not with NHR were observed. In addition, there were significant correlations of G with VHI and VHI-P (one of subscale of VHI). However, none of acoustic measures were correlated with the patient's subjective rating scales.

• Speech Sciences
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• v.14 no.3
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• pp.111-125
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• 2007

It is important to examine patients' subjective evaluation as well as objective measures and clinician's rating to assess voice disorders. This study aimed to evaluate validity and reliability of Korean-version of Voice Handicap Index (KVHI) and Voice-Related Quality of Life (KVQOL) with 113 adults with voice disorders and 111 normal adults. Content validity was verified by three experienced speech-language pathologists. Concurrent validity was revealed by examining the correlation among KVHI, KVQOL, and Voice Rating Scale as well as item discrimination coefficients. Total scores of KVHI and KVQOL of adults with voice disorders were significantly different from those of normal adults. Test-retest reliability and internal consistencies were significantly high in both KVHI and KVQOL. Correlations among scores of each subscale and total score were also significantly high in each tool. The study revealed that KVHI and KVQOL are suitable tools to be used in clinics and research areas in Korea, which can subjectively evaluate the effects of voice disorders on daily life as well as on quality of life.

• Phonetics and Speech Sciences
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• v.7 no.2
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• pp.47-54
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• 2015

The objectives of this study are to research the frequency of depression symptom in patients with voice disorders and to investigate parameters associated with depression from voice evaluation. A hundred ninety six patients(106 males and 90 females) who had been diagnosed with voice disorders first in their lifetime were selected. All the patients were examined by laryngeal stroboscopy. For depression and voice study, personal interview, acoustic and aerodynamic analysis, voice handicap index(VHI), reflux symptom index(RSI), and beck depression index(BDI) were done respectively. Mild to severe BDI were seen in 26.2%(52 patients) of the whole patients. A BDI mean score of female patients was $8.8{\pm}7.5$ which was higher than that of male patients($5.6{\pm}6.6$), the difference observed being statistically significant(p<0.001). In the acoustic analysis, the score of sent_duration parameter was increasing in the patients with depression, which was significantly higher than the score of the patients without depression(p<0.05). In the addition, the scores of VHI and RSI were higher in the patients with depression(p<0.001). Our findings suggest that the prevalence of depression in patients with voice disorders is related to female, speaking velocity, and self-questionnaire. This result can be used for psychologically based approach to therapy.