The effect of the auditory signal on videolaryngostroboscopy ratings and interpretation



      The primary aim of this study was to examine the effect of the videolaryngostroboscopic auditory signal on videolaryngostroboscopy (VLS) ratings and interpretation in normophonic and dysphonic speakers.

      Study Design

      Prospective repeated measures design


      Eight speech-language pathologists evaluated rigid VLS exams obtained from 12 dysphonic speakers with vocal fold pathology and 4 normophonic speakers with normal VLS exams. VLS exams were evaluated with the auditory signal present and absent with a washout period between rating sessions. VLS measures were obtained using the Voice-vibratory Assessment of Laryngeal Imaging (VALI) and a 100mm visual analog scale (VAS). The effects of the auditory signal and its interaction with voice quality severity on 9 VLS ratings, diagnostic billing codes, and treatment recommendations were examined.


      There was no effect of auditory information on VLS measures or overall severity of laryngeal function evaluated using the VAS (ps > 0.05). There was a main effect of auditory information and a significant interaction with voice quality severity for only one VLS measure (non-vibrating portion-left) evaluated using the VALI (P = 0.05). Post-hoc analysis for this rating showed significant increases (t-test adjusted P < 0.05) when voice quality severity was moderate-severe (M = 4.8%; SD = 1.65%) and auditory information was present. Agreement in individual clinician's selection of diagnostic codes (73%) and treatment recommendations (65.6%) when auditory cues were present and absent was moderate to high.


      The presence of the videolaryngostroboscopic auditory signal had a minimal effect on VLS ratings, treatment recommendations, or diagnostic billing codes.

      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


      1. ASHA Practice Portal. Available at:

        • Patel RR
        • Awan SN
        • Barkmeier-Kraemer J
        • et al.
        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 Lang Pathol. 2018; 27: 887-905
        • Eller R
        • Ginsburg M
        • Ginsburg Lurie D
        • Heman-Ackah Lyons
        • et al.
        Flexible Laryngoscopy: A Comparison of Fiber Optic and Distal Chip Technologies. Part 1: Vocal Fold Masses.
        J Voice. 2008; 22: 746-750
        • Mehta DD
        • Hillman RE
        Current role of stroboscopy in laryngeal imaging.
        Curr Opin Otolaryngol Head Neck Surg. 2012; 20: 429-436
        • Mendelsohn AH
        • Remacle M
        • Courey MS
        • et al.
        The diagnostic role of high-speed vocal fold vibratory imaging.
        J Voice. 2013; 27: 627-631
        • Paul BC
        • Chen S
        • Sridharan S
        • et al.
        Diagnostic accuracy of history, laryngoscopy, and stroboscopy.
        Laryngoscope. 2013; 123: 215-219
        • Rosen CA
        Stroboscopy as a research instrument: development of a perceptual evaluation tool.
        Laryngoscope. 2005; 115: 423-428
        • Bonilha HS
        • Focht KL
        • Martin-Harris B
        Rater methodology for stroboscopy: a systematic review.
        J Voice. 2015; 29: 101-108
        • Nawka T
        • Konerding U
        The interrater reliability of stroboscopy evaluations.
        J Voice. 2012; 26 (812.e1-10)
        • Bonilha HS
        • Desjardins M
        • Garand KL
        • et al.
        Parameters and Scales Used to Assess and Report Findings From Stroboscopy: A Systematic Review.
        J Voice. 2018; 32: 734-755
        • Sauder C
        • Nevdahl M
        • Kapsner-Smith M
        • Eadie T
        Does the accuracy of case history affect interpretation of videolaryngostroboscopic exams?.
        The Laryngoscope. 2019; (Published online May 24lary.28081)
        • Teitler N
        Examiner bias: influence of patient history on perceptual ratings of videostroboscopy.
        J Voice. 1995; 9: 95-105
      2. Eadie T, Sroka A, Wright DR, et al. Does Knowledge of Medical Diagnosis Bias Auditory-Perceptual Judgments of Dysphonia?(Report). 2011;25:420.

        • Sauder C
        • Eadie T
        Does the Accuracy of Medical Diagnoses Affect Novice Listeners’ Auditory-Perceptual Judgments of Dysphonia Severity?.
        J Voice. 2020; 34: 197-207
        • Bytzer P
        Information Bias in Endoscopic Assessment.
        Am J Gastroenterol. 2007; 102: 1585-1587
        • Hatala R
        • Norman GR
        • Brooks LR
        Impact of a clinical scenario on accuracy of electrocardiogram interpretation.
        J Gen Intern Med. 1999; 14: 126-129
        • Leblanc VR
        • Brooks LR
        • Norman GR
        Believing is seeing: the influence of a diagnostic hypothesis on the interpretation of clinical features.
        Acad Med. 2002; 77: S67-S69
        • Shikino K
        • Ikusaka M
        • Ohira Y
        • et al.
        Influence of predicting the diagnosis from history on the accuracy of physical examination.
        Adv Med Educ Pract. 2015; 6: 143-148
        • Poburka B
        • Bless D
        A Multi-Media, Computer-Based Method for Stroboscopy Rating Training.
        J Voice. 1998; 12: 513-526
        • Yiu E
        • Lau V
        • Ma E
        • et al.
        Reliability of laryngostroboscopic evaluation on lesion size and glottal configuration: A revisit.
        The Laryngoscope. 2014; 124: 1638-1644
        • Poburka BJ
        • Patel RR
        • Bless DM
        Voice-Vibratory Assessment With Laryngeal Imaging (VALI) Form: Reliability of Rating Stroboscopy and High-speed Videoendoscopy.
        J Voice. 2017; 31: 513.e1-513.e14
        • KayPENTAX
        Instruction manual: Stroboscopy systems and components.
        2008 (Montvale, NJ)
        • Chandran S
        • Hanna J
        • Lurie D
        • et al.
        Differences between flexible and rigid endoscopy in assessing the posterior glottic chink.
        J Voice. 2011; 25: 591-595
        • Makki F
        • F.
        • Hilal A
        • Fung E
        • et al.
        Accuracy of flexible versus rigid laryngoscopic photo-documentation in the diagnosis of early glottic cancer.
        JLO. 2013; 127: 890-896
        • Rzepakowska A
        • Sielska-Badurek E
        • Osuch-Wojcikiewicz E
        • et al.
        The predictive value of videostroboscopy in the assessment of premalignant lesions and early glottis cancers..
        Otolaryngol Pol. 2017; 71: 14-18
        • Uloza V
        • Vegienė, A
        • Šaferis V
        Correlation Between the Basic Video Laryngostroboscopic Parameters and Multidimensional Voice Measurements.
        J Voice. 2013; 27: 744-752
        • Casiano RR
        • Zaveri V
        • Lundy DS
        Efficacy of Videostroboscopy in the Diagnosis of Voice Disorders.
        Otolaryngol Head Neck Surg. 1992; 107: 95-100
        • Cohen SM
        • Kim J
        • Roy N
        • et al.
        Change in diagnosis and treatment following specialty voice evaluation: A national database analysis.
        Laryngoscope. 2015; 125: 1660-1666
        • Woo P
        Aerodynamic and Stroboscopic Findings before and after Microlaryngeal Phonosurgery.
        J Voice. 1994; 8: 186-194
        • Kempster GB
        • Gerratt BR
        • Verdolini Abbott K
        • et al.
        Consensus auditory-perceptual evaluation of voice: development of a standardized clinical protocol.
        Am J Speech Lang Pathol. 2009; 18: 124-132
        • Zraick RI
        • Kempster GB
        • Connor NP
        • et al.
        Establishing validity of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V).
        Am J Speech Lang Pathol. 2011; 20: 14-22
        • Portney L
        • Watkins M
        Construct validity. Foundations of Clinical Research: Applications to Practice.
        Prentice Hall Health New Jersey, USA. Published online 2000; : 87-91
        • Karnell MP
        • Melton SD
        • Childes JM
        • et al.
        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
        • Cohen SM
        • Kim J
        • Roy N
        • et al.
        Delayed otolaryngology referral for voice disorders increases health care costs..
        Am J Med. 2015; 128 (426.e11-18)
        • Jones JW
        • Perryman M
        • Judge P
        • et al.
        Resident Education in Laryngeal Stroboscopy and Perceptual Voice Evaluation: An Assessment.
        J Voice. Published online 2018;
        • Roy N
        • Barton ME
        • Smith ME
        • et al.
        An in vivo model of external superior laryngeal nerve paralysis.
        Laryngoscope. 2009; 119: `1017-1032
        • Heller A
        • Tanner K
        • Roy N
        • et al.
        Voice, Speech, and Laryngeal Features of Primary Sjögren's Syndrome.
        Ann Otol Rhinol Laryngol. 2014; 123: 778-785
        • Allensworth JJ
        • O'Dell K
        • Ziegler A
        • et al.
        Treatment Outcomes of Bilateral Medialization Thyroplasty for Presbylaryngis.
        J Voice. 2019; 33: 40-44
      3. IBM Corp. Released 2017. IBM SPSS Statistics for Mac, Version 26.0. Armonk, NY: IBM Corp.

        • Shrout PE
        • Fleiss JL
        Intraclass correlations: Uses in assessing rater reliability.
        Psychological Bulletin. 1979; 86: 420-428
        • Hallgren KA
        Computing Inter-Rater Reliability for Observational Data: An Overview and Tutorial.
        Tutor Quant Methods Psychol. 2012; 8: 23-34
        • Landis JR
        • Koch GG
        The measurement of observer agreement for categorical data.
        Biometrics. 1977; 33: 159-174
      4. Roy N, Barkmeier-Kraemer J, Eadie T, et al. Evidence-Based Clinical Voice Assessment: A Systematic Review. 2013;22:212-226.

        • Martin-Harris B
        • Brodsky MB
        • Michel Y
        • et al.
        MBS Measurement Tool for Swallow Impairment—MBSImp: Establishing a Standard.
        Dysphagia. 2008; 23: 392-405
        • Patel R
        • Daily S
        • Bless D
        Comparison of High-Speed Digital Imaging with Stroboscopy for Laryngeal Imaging of Glottal Disorders.
        Ann Oto Rhinol Larygol. 2008; : 413-424