Auditory-Perceptual Analysis

Perceptual signs of voice problems:

• Quality (Roughness or Hoarseness)

• Pitch (F0)

• Loudness (Intensity)

• Other behaviors

  • Stridor

  • Excessive throat clearing

• Aphonia (loss of voice)

What is Auditory-Perceptual Assessment?

• Monitoring changes in voice production that may reflect improvement or worsening of vocal quality

• Variation in inter-rater & intra-rater reliability

• Collection

  • Standardized elicited task section

  • Spontaneous speech

What are the Auditory-Perceptual Analysis Tasks?

• Sustained vowel

• Sustained /s/ & /z/

• Singing up the musical scale

• Soft-loud voice production

• Oral reading: standard passage

• Free conversation

• Coughing, throat clearing, laughter

• Specific words/sentences; varying loudness & pitch

Sustained vowel:

• Objective: Judge voice quality, glottal competence s/z

• Expected Behavior: Duration = 18-20 sec

Sustained /s/ & /z/:

• Objective: Ratio → estimate glottal efficiency

• Expected Behavior: 1.4 or less

Singing up the musical scale:

• Objective: Estimate speaking pitch range

• Expected Behavior: 16 notes (2 octaves)

Soft-loud voice production:

• Objective: Assess ability to vary loudness & produce a shout

• Expected Behavior: Appropriate shout; adequate loudness, variation

Oral reading - standard passage:

• Objective: Compare to sustained vowel/free conversation

• Expected Behavior: Variations in pitch/loudness; adequate replenishing breaths

Free conversation:

• Objective: Compare to sustained vowel/oral reading; assess effects of emotion on voice

• Expected Behavior: As above for oral reading (w/ more inflection); voice production is consistent

Coughing, throat clearing, laughter:

• Objective: Assess nonspeech VF behavior

• Expected Behavior: Sharp glottal coup

Specific words/sentences; varying loudness & pitch:

• Objective: Elicit hard glottal attack, adductor/abductor spasm, tremor, seek variations in voice disorder

• Expected Behavior: Absence of symptoms

What are Auditory-Perceptual Characteristics?

• Voice quality varies in patients w/ structural pathology & often reflects…

  • Lesion severity (size & site of lesion & the depth of invasion into deeper layers of the VF)

  • Patients habitual voice use patterns

  • Presence/Absence of compensatory adjustments?

    • “Productive” (e.g., adaptive changes including improved breath support, enhanced vocal tract tuning, appropriate changes in pitch & loudness)

    • “Maladaptive” (e.g., extreme muscle activation/effort, poor tone focus, inappropriate changes in pitch & loudness)

GRBAS:

• Grade (degree of dysphonia)

• Roughness (irregularity heard in vocal fold vibration)

• Breathiness(airturbulence)

• Asthenia (weakness or decreased loudness)

• Strain (tight voice quality related to perceived hyperfunction)

• Rated on 4-point scale

  • 0 - normal; 1 - mild; 2 - moderate; and 3 - severe

  • G2 R2 B1 A0 S2

• Used internationally but no recognized standardization

What are the CAPE-V Vocal Attributes?

• Overall Severity

• Roughness

• Breathiness

• Strain

• Pitch

• Loudness

Overall Severity:

• Impression of voice deviance

Roughness:

• Perceived irregularity in voice

Breathiness:

• Audible air escape

Strain:

• Perception of excessive vocal effort

Pitch:

• Perceptual correlate of fundamental frequency (F0)

Loudness:

• Perceptual correlate of sound intensity

What are CAPE-V Tasks?

• Sustained vowels

• Sentences

• Conversational Speech

Sustained vowels:

• Lax vowel /a/

• Tense vowel /i/

Sentences:

• The blue spot is on the key again

• How hard did he hit him?

• We were away a year a go

• We eat eggs every Easter

• My mama makes lemon jam

• Peter will keep at the peak

Conversational Speech:

• At least 20 seconds of spontanoeus natural speech

Example Report:

• Moderate to severe degree of overall dysphonia (78/100), moderate roughness (56/100), moderate to severe breathiness (74/100), & strain (62/100). Modal pitch (35/100) was judged to be mild-moderately low for the person’s age/gender, while loudness (0/100) was judged to be normal. All voice attributes were judged as consistently present in this assessment. Mild hypernasality was also observed.