Examining the Relationship between Subjective and Objective Measures of Vocal function

Anne Pijper, Shashividan Hirani, Ruth Epstein

Key to the success of diagnosis and intervention in voice disorders is a knowledge and understanding of available perceptual and objective measures of voice. Equally important is the patient’s perception of his/her voice problem. A comparison of patient perceptions, professional perceptions and objective analysis of voice characteristics provides a comprehensive and meaningful picture of the disorder and has implications for management choice.
This study examines the relationship between (a) patient and professional perceptual ratings of voice and (b) perceptual ratings and objective acoustic analysis of vocal parameters.
A convenience sample of 15 patients, who had been referred for voice therapy, rated their own voice quality, severity, pitch and loudness according to a modified form of the GRBAS rating scale.
A specialist Speech and Language Therapist rated the patients’ voices independently, using the same scale. A blinded rating was performed by a second voice professional to determine inter-rater reliability.
Patients’ voices were recorded directly onto the Advanced Multidimensional Voice Programme for acoustic analysis.
Patient and professional perceptual rating data, as well as objective data were subjected to correlation analyses.
Patient and professional GRBAS ratings indicated the strongest correlation for ratings of roughness and the weakest correlation for ratings of pitch. Patients rated their own voices more harshly than professionals on parameters of grade, roughness, asthenia and strain. Patients’ self-ratings tended to correlate more highly with objective measures than professionals’.

Mrs Anne Pijper, Specialist Speech and Language Therapist, The Royal National Throat, Nose and Ear Hospital, London.
Mr Shashividan Hirani, Research Fellow, Institute of Laryngology and Otology, University College London.
Dr Ruth Epstein, Senior Lecturer, Institute of Laryngology and Otology, University College London.
Postal address: Mrs A Pijper
Speech and Language Therapy Department (ENT)
3^rd Floor Wicklow Building
The Royal National Throat, Nose and Ear Hospital
Gray’s Inn Road
London WC1X 8DA
Tel: 020 7915 1480 Fax: 01732 461711
e-mail address: anne.pijper@royalfree.nhs.uk