Research Article| Volume 24, ISSUE 5, P556-563, September 2010

Toward a More Quantitative Measure to Assess Severity of Dysphonia: Preliminary Observations

  • Natalie Schaeffer
    Address correspondence and reprint requests to Natalie Schaeffer, DA, Department of Speech Communication Arts and Sciences, Brooklyn College, 2900 Bedford Avenue, Boylan Hall, Room 4400, Brooklyn, NY 11210.
    Department of Speech Communication Arts and Sciences, Brooklyn College, Brooklyn, New York
    Search for articles by this author
  • Aimee Sidavi
    Department of Speech Communication Arts and Sciences, Brooklyn College, Brooklyn, New York
    Search for articles by this author


      Rating scales to determine the severity of dysphonia have shown considerable inter-rater variability. The objective of this study, therefore, was to investigate a more quantitative measure to perceptually rate the severity of dysphonia. The study was conducted on 10 participants with abuse-related dysphonia in two conditions, spontaneous speech, and paragraph reading. Four speech-language pathologists, who had experience with voice disorders, and one trained student counted the frequency of the nondysphonic syllables during the above two conditions. The voice samples were both recorded and transcribed for simultaneous analysis. All the recordings were randomized when presented to the raters. The raters circled the nondysphonic syllables while listening to each participant's recording. The nondysphonic syllables were counted, and a percentage of dysphonic severity was calculated for each participant to obtain a dysphonic severity percentage. Specific characteristics (eg, breathiness, noise, strain) were not specifically addressed, as they were components of the percentage of dysphonia obtained. The Cronbach's alpha revealed very high inter-rater reliability and high correlations among the raters for both spontaneous speech and paragraph reading, indicating reduced variability in raters' perceptions. This method appeared to be a more quantitative measure of perceptual ratings than current scales, which use general gradations of dysphonic severity. In addition, a naïve rater was successfully trained to use this method. This technique has the potential to be used in both pre- and posttherapy analysis, as well as during therapy, to determine progress.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Voice
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Sansone F.E.
        • Emanual F.W.
        Spectral noise levels and roughness severity ratings for normal and simulated rough vowels produced by adult males.
        J Speech Hear Res. 1970; 13: 489-502
        • Yiu E.M.-L.
        • Ng C.-Y.
        Equal appearing interval and visual analogue scaling of perceptual roughness and breathiness.
        Clin Linguist Phon. 2004; 18: 211-229
        • Wuyts L.
        • DeBodt M.S.
        • Van de Heyning P.H.
        Is the reliability of a visual analog scale higher than an ordinal scale? An experiment with the GRBAS scale for perceptual evaluation of dysphonia.
        J Voice. 1999; 13: 508-517
        • ASHA
        Consensus-auditory-perceptual-evaluation of voice (CAPE-V). The American Speech-Language-Hearing Association, Special Interest, Div. 3.
        Voice Voice Disord. 2002–2006; : 1-3
        • Hirano M.
        Psycho-acoustic evaluation of voice.
        Clinical Examination of Voice. Springer Verlag, Wien New York1981 (81–84)
        • Kreiman J.
        • Gerratt B.R.
        • Kempster G.B.
        • Erman A.
        • Berke G.S.
        Perceptual evaluation of voice quality: review, tutorial, and a framework for future research.
        J Speech Hear Res. 1993; 36: 21-40
        • Kreiman J.
        • Gerratt B.R.
        • Precoda K.
        • Berke G.S.
        Individual difference in voice quality perception.
        J Speech Hear Res. 1992; 35: 512-520
        • ANSI
        S1. 1-1960, Acoustical Terminology.
        American National Standards Institute, New York1960
      1. Kreiman J, Vanlancker-Sidtis D, Gerratt B. Defining and measuring voice quality. Conference at Massachusetts Institute of Technology; 2004: June 11–June 13, 2004 at MIT.

        • Chan M.K.
        • Yiu E.M.-L.
        The effect of anchors and training on the reliability of perceptual voice evaluation.
        J Speech Lang Hear Res. 2002; 45: 111-126
        • Kreiman J.
        • Gerratt B.R.
        Perception of aperiodicity in pathological voice.
        J Acoust Soc Am. 2005; 117: 2201-2211
        • Shrivastav R.
        • Sapienza C.M.
        • Nandur V.
        Application of psychometric theory to the measurement of voice quality using rating scales.
        J Speech Lang Hear Res. 2005; 48: 323-335
        • van As C.J.
        • Koopmans-van Beinum F.J.
        • Pols L.C.W.
        • Hilgers F.J.M.
        Perceptual evaluation of tracheoesophgeal speech by naïve and experienced judges through the use of semantic differential scales.
        J Speech Lang Hear Res. 2003; 46: 947-959
        • Kempster G.B.
        • Kistler D.J.
        • Hillenbrand J.
        Multidimensional scaling analysis of dysphonia in two speaker groups.
        J Speech Hear Res. 1991; 34: 534-543
        • Wolfe V.
        • Fitch J.
        • Cornell R.
        Acoustic prediction of severity in commonly occurring voice problems.
        J Speech Hear Res. 1995; 38: 273-279
        • de Krom G.
        Consistency and reliability of voice quality ratings for different types of speech fragments.
        J Speech Hear Res. 1994; 37: 985-999
        • Patel S.
        • Shrivastav R.
        Perception of dysphonic vocal quality: some thoughts and research update.
        Perspect Voice Voice Disord. July, 2007; 17 (ASHA, Div. 3): 3-7
        • Isshiki N.
        • Yanagihara N.
        • Morimoto M.
        Approach to the objective diagnosis of hoarsness.
        Folia Phoniatr. 1966; 18: 393-400
        • Fukazawa T.
        • El-Assuooty A.
        • Honjo I.
        A new index for evaluation of turbulent noise in pathological voice.
        J Acoust Soc Am. 1988; 83: 1189-1193
        • Gerratt B.R.
        • Kreiman J.
        • Antonanzas-Barroso N.
        • Berke G.S.
        Comparing internal and external standards in voice quality judgments.
        J Speech Hear Res. 1993; 36: 14-20
        • Zwirner P.
        • Murry T.
        • Woodson G.E.
        Perceptual-acoustic relationships in spasmodic dysphonia.
        J Voice. 1993; 7: 165-171
        • Kreiman J.
        • Gerratt B.R.
        • Precoda K.
        Listener experience and perception of voice quality.
        J Speech Hear Res. 1990; 33: 103-115
        • Bassich C.J.
        • Ludlow C.L.
        The use of perceptual methods by new clinicians for assessing voice quality.
        J Speech Hear Disord. 1986; 51: 125-132
        • American Thoracic Society
        Standardization of spirometry—1987 update.
        Am Rev Respir Dis. 1987; 136: 1285-1289
        • Blitzer A.
        • Pillsbury H.
        • Jahn A.F.
        • Binder W.
        Office Based Surgery in Otolaryngology.
        Georg Thieme Verlag, New York1998 (153–154)
        • Riley G.D.
        Stuttering Severity Instrument for Children and Adults.
        3rd ed. Pro-Ed., Austin, TX1994
        • McManus P.
        Effective Microphone Techniques for Speakers.
        Paul R. McManus, San Diego2004
        • Anderson V.A.
        Training the Speaking Voice.
        2nd ed. Oxford University Press, New York1961
        • Eskenazi L.
        • Childers D.G.
        • Hicks D.M.
        Acoustic correlates of vocal quality.
        J Speech Hear Res. 1990; 33: 298-306
        • Martin D.
        • Fitch J.
        • Wolfe V.
        Pathologic voice type and the acoustic prediction of severity.
        J Speech Hear Res. 1995; 38: 765-771
        • Parsa V.
        • Jamieson D.G.
        Acoustic discrimination of pathological voice: sustained vowels versus continuous speech.
        J Speech Lang Hear Res. 2001; 44: 327-339
        • Bele I.V.
        Reliability in perceptual analysis of voice quality.
        J Voice. 2005; 19: 555-573
        • Rabinov C.R.
        • Kreiman J.
        • Gerratt B.R.
        • Bielamowicz S.
        Comparing reliability of perceptual ratings of roughness and acoustic measures of jitter.
        J Speech Hear Res. 1995; 38: 26-32