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Consensus for voice quality assessment in clinical practice: guidelines of the European Laryngological Society and Union of the European Phoniatricians

  • Laryngology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Introduction

To update the European guidelines for the assessment of voice quality (VQ) in clinical practice.

Methods

Nineteen laryngologists–phoniatricians of the European Laryngological Society (ELS) and the Union of the European Phoniatricians (UEP) participated to a modified Delphi process to propose statements about subjective and objective VQ assessments. Two anonymized voting rounds determined a consensus statement to be acceptable when 80% of experts agreed with a rating of at least 3/4. The statements with ≥ 3/4 score by 60–80% of experts were improved and resubmitted to voting until they were validated or rejected.

Results

Of the 90 initial statements, 51 were validated after two voting rounds. A multidimensional set of minimal VQ evaluations was proposed and included: baseline VQ anamnesis (e.g., allergy, medical and surgical history, medication, addiction, singing practice, job, and posture), videolaryngostroboscopy (mucosal wave symmetry, amplitude, morphology, and movements), patient-reported VQ assessment (30- or 10-voice handicap index), perception (Grade, Roughness, Breathiness, Asthenia, and Strain), aerodynamics (maximum phonation time), acoustics (Mean F0, Jitter, Shimmer, and noise-to-harmonic ratio), and clinical instruments associated with voice comorbidities (reflux symptom score, reflux sign assessment, eating-assessment tool-10, and dysphagia handicap index). For perception, aerodynamics and acoustics, experts provided guidelines for the methods of measurement. Some additional VQ evaluations are proposed for voice professionals or patients with some laryngeal diseases.

Conclusion

The ELS-UEP consensus for VQ assessment provides clinical statements for the baseline and pre- to post-treatment evaluations of VQ and to improve collaborative research by adopting common and validated VQ evaluation approach.

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Data availability

Data are available on request.

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Funding

This study has not received any support from funding agencies.

Author information

Author notes

  1. Jerome R. Lechien and Ahmed Geneid have equally contributed to the paper and have to be joined as co-first authors.

  2. Frederik G. Dikkers and Lise Crevier-Buchman have equally contributed to the paper and have to be joined as co-senior authors.

Authors and Affiliations

  1. Department of Otolaryngology-Head Neck Surgery, Foch Hospital, University of Paris Saclay, Paris, France

    Jerome R. Lechien, Stephane Hans, Marc J. Remacle & Lise Crevier-Buchman

  2. Department of Otolaryngology-Head Neck Surgery, CHU Saint-Pierre, Brussels, Belgium

    Jerome R. Lechien

  3. Department of Laryngology and Broncho-Esophagology, EpiCURA Hospital, Anatomy Department of University of Mons, Mons, Belgium

    Jerome R. Lechien

  4. Phonetics and Phonology Laboratory (UMR 7018 CNRS, Université Sorbonne Nouvelle/Paris 3), Paris, France

    Jerome R. Lechien, Stephane Hans & Lise Crevier-Buchman

  5. Department of Otolaryngology and Phoniatrics-Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland

    Ahmed Geneid

  6. Department of Phoniatrics and Speech Pathology, Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland

    Jörg E. Bohlender

  7. Department of Otolaryngology and Head and Neck Surgery Fondazione, IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

    Giovanna Cantarella

  8. Department of Clinical Sciences and Community Health Università degli Studi di Milano, Milan, Italy

    Giovanna Cantarella

  9. Department of Surgery, Otolaryngology Service. Hospital Universitario Mayor Mederi, Universidad del Rosario, Bogotá, Colombia

    Juan C. Avellaneda

  10. ENT, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium

    Gauthier Desuter

  11. Department of Otorhinolaryngology, Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands

    Elisabeth V. Sjogren

  12. Department of Otorhinolaryngology-Head and Neck Surgery, CHU de Liege, Université de Liège, Liège, Belgium

    Camille Finck

  13. Medical Voice Center (MEVOC), Hamburg, Germany

    Markus Hess

  14. Department of Otolaryngology, Fonomer, Ankara, Turkey

    Haldun Oguz

  15. Department of Otorhinolaryngology-Head and Neck Surgery, Center Hospitalier de Luxembourg, Eich, Luxembourg

    Marc J. Remacle

  16. Department of Otorhinolaryngology Medical, University of Vienna, Vienna, Austria

    Berit Schneider-Stickler

  17. Department of Otolaryngology, Head and Neck Surgery, Comenius University, University Hospital, Bratislava, Slovakia

    Miroslav Tedla

  18. Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, Italy

    Antonio Schindler

  19. Department of Otorhinolaryngology, Hospital Clínic, Barcelona, Spain

    Isabel Vilaseca

  20. University of Barcelona, Barcelona, Spain

    Isabel Vilaseca

  21. Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Motol, First Faculty of Medicine, Charles University, Prague, Czech Republic

    Michal Zabrodsky

  22. Department of Otorhinolaryngology-Head and Neck Surgery, Amsterdam UMC Location AMC, University of Amsterdam, Amsterdam, The Netherlands

    Frederik G. Dikkers

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  1. Jerome R. Lechien
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  2. Ahmed Geneid
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  3. Jörg E. Bohlender
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Contributions

JRL: design, acquisition of data, data analysis & interpretation, drafting, final approval, and accountability for the work; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. AG: design, acquisition of data, data analysis & interpretation, drafting, final approval, and accountability for the work; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. ES: design, acquisition of data, data analysis & interpretation, drafting, final approval, and accountability for the work; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. FD: design, acquisition of data, data analysis & interpretation, agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. SH: design, acquisition of data, data analysis & interpretation, agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. JEB: data analysis & interpretation, agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. JA: data analysis & interpretation, agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. GC: data analysis & interpretation, agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. GD: data analysis & interpretation, agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. CF: data analysis & interpretation, drafting, final approval, and accountability for the work; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. MH: data analysis & interpretation, drafting, final approval, and accountability for the work; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. HO: data analysis & interpretation, drafting, final approval, and accountability for the work; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. IV: data analysis & interpretation, drafting, final approval, and accountability for the work; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. AS: data analysis & interpretation, drafting, final approval, and accountability for the work; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. MT: final approval, and accountability for the work; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. MZ: final approval, and accountability for the work; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. MR: Delphi expert, final approval, and accountability for the work; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. BS-S: Delphi expert, final approval, and accountability for the work; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. LC-B: Delphi expert, final approval, and accountability for the work; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Jerome R. Lechien.

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Lechien, J.R., Geneid, A., Bohlender, J.E. et al. Consensus for voice quality assessment in clinical practice: guidelines of the European Laryngological Society and Union of the European Phoniatricians. Eur Arch Otorhinolaryngol 280, 5459–5473 (2023). https://doi.org/10.1007/s00405-023-08211-6

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