Voice Perception: The Speaker’s Experience

Heather Bonilha, PhD
Maude Desjardins, PhD

Throughout the years, research on self-perception of voice and associated quality of life gradually adopted the predominant role it occupies in today’s voice literature, along with the general movement towards a more patient-centered health care paradigm. This change in perspective has been extremely relevant for voice patients, for whom the perception of the voice by the physician or speech therapist can differ dramatically from the self-perceived experience, tinted by personal characteristics and lifestyle. The wide variety of voice disorders has led to the development and validation of several questionnaires to assess self-perception of voice quality and voice-related quality of life, such as the Voice Handicap Index, with a significant amount of publications related to the methodology of self-perceptual assessments. Researchers have worked on appreciating the clinical relevance of those measures by determining norms and cut-off values for ‘’normality’’, but also by investigating the correlation between self-perception and other voice measures.

Despite the large array of people affected by voice disorders, the vast majority of studies on self-assessment focuses on professional voice users, more specifically teachers and singers. Because their voice is their primary working tool, voice professionals are a suitable target population for the development and refinement of self-rating questionnaires. They usually present with an exacerbated awareness of their voice because they rely on it on a daily basis. For this reason, they are also sensitive to physical symptoms and sensations of pain and vocal effort and fatigue. When discussing perception, vocal quality is often what comes to mind; however, the perception of pain, effort and fatigue as well as their impact on quality of life represent major components of a dysphonic patient’s experience and can significantly hinder their day-to-day participation. The assessment of physical sensations is challenging and researchers have worked on developing and testing efficient measures as well as on gaining a better understanding of vocal fatigue and perceived effort by identifying their physiological and objective correlates.

As we know, voice disorders are not limited to professional voice users; they are various in nature and affect a significant amount of people of different ages, genders and nationalities. These factors are susceptible to shape the patient’s perception of their voice and voice-related quality of life and this has been taken into consideration by researchers as evidenced by the large number of publications on cultural adaptations of self-assessment questionnaires, as well as with creation and validation of instruments specific to populations such as transgender people and patients with voice disorders such as paradoxical vocal fold movement disorder, adductory spasmodic dysphonia or age-related dysphonia. Specific questionnaires were also developed to appraise dysphonic children’s perception of their own voice and parents’ ratings of their child’s voice. In fact, a child’s voice disorder is likely to impact the whole family’s communication and dynamics and the parents’ perception of the disorder, as well as their involvement in the therapy process, are often essential for success.

Self-perceptual ratings of voice quality and voice-related quality of life are a central part of voice evaluations, and therefore they are used as outcome measures in a large majority of voice therapy studies. For the purpose of this review, only papers with a specific focus on self-perception and quality of life assessments were included. Because of the vast number of articles of this topic, we chose to select a sample that would depict a representative picture of past and current research in the area.

This volume is a companion to the volume on auditory-perceptual judgments of voice quality and contains four main sections: 1) Adults-General; 2) Professional Voice Users; 3) Pediatric Voice; and 4) Specific Conditions. We hope that it will provide the reader with an overall vision of a complex and multi-faceted subject that is central to our contemporary model of care.