title: Can we perceptually rate alaryngeal voice? Developing the Sunderland Tracheoesophageal Voice Perceptual Scale.
abstract: OBJECTIVE
  To investigate the inter and intra reliability of raters (in relation to both profession and expertise) when judging two alaryngeal voice parameters: 'Overall Grade' and 'Neoglottal Tonicity'. Reliable perceptual assessment is essential for surgical and therapeutic outcome measurement but has been minimally researched to date.
  
  
  METHODS
  Test of inter and intra rater agreement from audio recordings of 55 tracheoesophageal speakers.
  
  
  METHODS
  Cancer Unit.
  
  
  METHODS
  Twelve speech and language therapists and ten Ear, Nose and Throat surgeons.
  
  
  METHODS
  Perceptual voice parameters of 'Overall Grade' rated with a 0-3 equally appearing interval scale and 'Neoglottal Tonicity' with an 11-point bipolar semantic scale.
  
  
  RESULTS
  All raters achieved 'good' agreement for 'Overall Grade' with mean weighted kappa coefficients of 0.78 for intra and 0.70 for inter-rater agreement. All raters achieved 'good' intra-rater agreement for 'Neoglottal Tonicity' (0.64) but inter-rater agreement was only 'moderate' (0.40). However, the expert speech and language therapists sub-group attained 'good' inter-rater agreement with this parameter (0.63). The effect of 'Neoglottal Tonicity' on 'Overall Grade' was examined utilising only expert speech and language therapists data. Linear regression analysis resulted in an r-squared coefficient of 0.67. Analysis of the perceptual impression of hypotonicity and hypertonicity in relation to mean 'Overall Grade' score demonstrated neither tone was linked to a more favourable grade (P = 0.42).
  
  
  CONCLUSIONS
  Expert speech and language therapist raters may be the optimal judges for tracheoesophageal voice assessment. Tonicity appears to be a good predictor of 'Overall Grade'. These scales have clinical applicability to investigate techniques that facilitate optotonic neoglottal voice quality.
authors.affiliation: Speech and Language Therapy, Sunderland Royal Hospital, Sunderland, UK. anne.hurren1@ncl.ac.uk
authors.forename: A
authors.initials: A
authors.lastname: Hurren
authors.forename: A J
authors.initials: AJ
authors.lastname: Hildreth
authors.forename: P N
authors.initials: PN
authors.lastname: Carding
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007825:Laryngectomy; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D013067:Speech Perception; D013071:Speech, Alaryngeal; D011795:Surveys and Questionnaires; D014832:Voice Disorders / Q000453:epidemiology; D014833:Voice Quality