SUMMARY
Objective
To determine if auditory-perceptual voice ratings performed using the GRBAS scale
correlate with acoustic and aerodynamic measures of voice. A secondary aim was to
examine the relationship between GRBAS ratings and patient-reported quality of life
scales.
Methods
GRBAS ratings, acoustic, aerodynamic and patient-reported quality of life ratings
were collected from the University of Wisconsin Madison Voice and Swallow Outcomes
Database for 508 adults with voice disorders. Acoustic measures included noise to
harmonic ratio, jitter%, shimmer%, highest fundamental frequency (F0) of vocal range,
lowest F0 of vocal range, maximum phonation time and dysphonia severity index. Aerodynamic
measures included phonation threshold pressure, subglottal pressure, mean transglottal
airflow and laryngeal airway resistance. Patient-reported quality of life measures
included the Vocal Handicap Index (VHI) and Glottal Function Index (GFI).
Results
GRBAS ratings were significantly correlated with several acoustic and aerodynamic
measures, VHI and GFI. The strongest significant correlations for acoustic measures
were observed between GRBAS ratings of overall voice quality and perturbation measures
(jitter% r = 0.58, shimmer% r = 0.45, noise to harmonic ratio r = 0.36, Dysphonia
Severity Index r = -0.56). The strongest significant correlation for aerodynamic voice
measures was observed between GRBAS ratings of breathiness and transglottal airflow
(r = 0.23), subglottal pressure (r = 0.49), and phonation threshold pressure (r =
0.26). GRBAS ratings were also significantly correlated with both VHI and the GFI
scales. R values were higher for the VHI, but remained largely in low range for both
scales.
Conclusions
Although GRBAS ratings were significantly correlated with multiple objective voice
and patient related quality of life ratings, r values were low. These findings support
the need for multiple voice measures when performing voice evaluations as no single
voice measure was highly correlated with voice quality as measured by the GRBAS scale.
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 accessOne-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:
Subscribe to Journal of VoiceAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
- Evidence-based clinical voice assessment: a systematic review.Am J Speech-Language Pathol. 2013; 22: 212-226
- Recommended protocols for instrumental assessment of voice: American speech-language-hearing association expert panel to develop a protocol for instrumental assessment of vocal function.Am J Speech-Language Pathol. 2018; 27: 887-905
- Use of aerodynamic measures in clinical voice assessment.Perspective on Voice and Voice Disorders. 2007; 17: 14-18
- Aerodynamic and temporal aspects of velopharyngeal function in normal speakers.J Speech Hear Res. 1996; 39: 1199-1207
- Aerodynamic and acoustic features of vocal effort.J Voice. 2014; 28: 144-153
- Aerodynamic transfer of energy to the vocal folds.J Acoust Soc Am. 2005; 118: 1689-1700
- Attitudes of children with dysphonia.J Voice. 2008; 22: 197-209
- Validation of an instrument to measure voice-related quality of life (V-RQOL).J Voice. 1999; 13: 557-569
- Voice-related complaints in the pediatric population.J Voice. 2009; 25
- Perceptual evaluation of voice quality and its correlation with acoustic measurements.J Voice. 2004; 18
- Classification of dysphonic voices: acoustic and auditory-perceptual measures.J Voice. 2005; 19: 1-14
- Perceptual evaluation of severe pediatric voice disorders: rater reliability using the Consensus Auditory-Perceptual Evaluation of Voice.J Voice. 2010; 24: 441-449
- Reliability of Clinician-Based (GRBAS and CAPE-V) and Patient-Based (V-RQOL and IPVI) documentation of voice disorders.J Voice. 2007; 21: 576-590
- Test-Retest study of the GRBAS Scale: influence of experience and professional background on perceptual rating of voice quality.J Voice. 1995; 11: 74-80
- The effect of perceptual training on inexperienced listeners judgements of dysphonic voice.J Voice. 2006; 20: 527-544
- Sources of listener disagreement in voice quality assessment.J Acoust Soc Am. 2000; 108: 1867-1876
- Clinical Examination of Voice.Springer-Verlag, Wien1981
- Establishing validity of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V).Am J Speech-Language Pathol. 2011; 20: 14-22
- GRBAS and CAPE-V scales: high reliability and consensus when applied at different times.J Voice. 2012; 26: 812.e17-812.e22
- The relationship between auditory-perceptual rating scales and objective voice measures in children with voice disorders.AJSLP. 2021; 30 (Epub ahead of issue)
- Consensus auditory-perceptual evaluation of voice: development of a standardized clinical protocol.Am J Speech Language Pathol. 2009; 18: 124-132
- Acoustic characteristics of normal and pathological voices.Speech and Language. 1979; 1: 271-335
- Aerodynamic measures of glottal function: what extra can they tell us and how do they guide management?.Curr Opin Otolaryngol Head Neck Surg. 2014; 22: 450-454
- The Voice Handicap Index (VHI): development and validation.Am J Speech-Lang Pat. 1997; 6: 66-70
- Validity and reliability of the glottal function index.Arch Otolaryngol Head Neck Surg. 2005; 131
- Acoustic analyses of sustained and running voices from patients with laryngeal pathologies.J Voice. 2008; 22: 1-9
- Correlation between acoustic measures, voice handicap index and GRBAS scales scores among Moroccan students.Int J Pediatrics. 2017;
- Pathological breathy and rough voice quality for different types of vowel fragments.J Speech and Hearing Res. 1995; 38: 794-811
- The relationship between cepstral peak prominence and selected parameters of dysphonia.J Voice. 2002; 16: 20-27
- Vocal improvement after voice therapyin unilateral vocal fold paralysis.J Voice. 2008; 22: 113-118
- Voice therapy for laryngeal hemiplegia: the role of timing of initiation of therapy.J Rehabil Med. 2010; 42: 442-446
- Pathologic voice type and the acoustic prediction of severity.J Speech Langauge and Hearing Res. 1995; 38
- Comparing reliability of perceptual ratings of roughness and acoustic measures of jitter.J Speech and Hearing Res. 1995; 38: 26-32
- Acoustic and perceptual classification of within-sample normal, intermittently dysphonic, and consistently dysphonic voice types.J Voice. 2017; 31: 218-228
- The Dysphonia Severity Index.J Speech Lang Hear Res. 2000; 43: 796-809
- The relationship between perceptual evaluation and objective multiparametric evaluation of dysphonia severity.J Voice. 2008; 22: 138-145
- The applicability of the Dysphonia Severity Index and the Voice Handicap Index in evaluating effects of voice therapy and phonosurgery.J Voice. 2010; 24: 199-205
- an examination of intrasubject variability on the Dysphonia Severity Index.J Voice. 2012; 26
- Correlation among the Dysphonia Severity Index (DSI), the RBH voice perceptual evaluation, and minimum glottal area in female patients with vocal fold nodules.J Voice. 2014; 28: 20-23
- Secondary voice outcomes of a randomized clinical trial comparing two head/neck strengthening exercises.J Speech and Hearing Res. 2019; 62: 318-323
- The utility of pitch elevation in the evaluation of oropharyngeal dysphagia: preliminary findings.Am J Speech Language Pathol. 2011; 20
- Determining the underlying relationship between swallowing and maximum vocal pitch elevation: a preliminary study of their hyoid biomechanics in healthy adults.JSLHR. 2020; 63: 3408-3418
- Efficacy of vocal function exercises as a method of improving voice production.J Voice. 1994; 8: 271-278
- Maximum phonation time: variability and reliability.J Voice. 2010; 24: 281-284
- Assessment of dysphonia due to benign vocal fold lesions by acoustic and aerodynamic indices: a multivariate analysis.Logopedics Phoniatrics Vocol. 2011; 36: 21-27
- Intrasubject reliability of maximum phonation time.J Voice. 2016; 30: 775.e1-775.e4
- Respiratory and laryngeal function during spontaneous speaking in teachers with voice disorders.Journal of Speech, Language, and Hearing Res. 2008; 51: 333-349
- Speech breathing during reading in women with vocal nodules.J Voice. 1997; 2: 195-201
- Aerodynamic and acoustic voice measurements of patients with vocal nodules: variation in baseline and changes across voice therapy.J Voice. 2003; 17: 269-282
- The relationship between physiological mechanisms and the self-perception of vocal effort.J Speech, Language and Hearing Res. 2019; 62: 815-834
- Evidence for distinguishing pressed, normal, resonant, and breathy voice qualities by laryngeal resistance and vocal efficiency in vocally, trained subjects.J Voice. 2007; 22: 546-552
- The physics of small-amplitude oscillation of the vocal folds.J Acoust Soc Am. 1988; 83: 1536-1552
- Assessment of phonation threshold pressure: a critical review and clinical implications.Am J Speech Lang Pathol. 2011; 20: 348-366
- Modulation of relative fundamental frequency during transient emotional states.J Voice. 2019; 33: 894-899
- Voice handicap index change following treatment of voice disorders.J Voice. 2000; 14: 619-623
- Cepstral peak prominence: a more reliable measure of dysphonia.Ann Otol, Rhinol, Laryngol. 2003; 112: 324-333
Article info
Publication history
Published online: March 06, 2021
Accepted:
February 9,
2021
Identification
Copyright
© 2021 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
