Validation of the Spanish Adaptation of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V)

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"identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Isabel" "apellidos" => "García-López" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Arántzazu" "apellidos" => "Ávila-Menéndez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Otorrinolaringología, Hospital Universitario Central de Asturias, Oviedo, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Otorrinolaringología, Hospital Universitario La Paz, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Logopedia, Facultad de Psicología, Universidad de Oviedo, Oviedo, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Adaptación fonética y validación del método de valoración perceptual de la voz CAPE-V al español" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1311 "Ancho" => 1626 "Tamanyo" => 50969 ] ] "descripcion" => array:1 [ "en" => "Concordance of general severity between the CAPE-V and GRBAS." ] ] ] "textoCompleto" => "IntroductionConceptually, the “ideal” method for carrying out auditory-perceptual voice assessment should fulfil the following conditions: analyse consistent vocal qualities that make it possible to clearly differentiate the normal voice from the pathological voice and compare its changes over time, maintain a specific correlation between the underlying physiopathology and the objective evaluation parameters, clearly specify the type of scale used in assessment, and describe the specific training of the observer.However, there are important obstacles that prevent any appraisal method from fulfilling these ideal conditions. The first is that no specific, standardised terminology that makes it possible to describe the type of voice alteration or stratify its severity exists. Standard parameters that define the normal voice are missing as well. Finally, and most important, there is little consistency, a matter that is inherent in all auditory-perceptual evaluations.Until now, perceptual judgement of the voice has been an uncertain task, marked by disagreements among phonology experts and variability in gathering and presenting data. Until now, no method has been shown to be better than others in measuring perceived vocal quality. Likewise, current knowledge is still considered inadequate for designing a clinical tool that could resolve all the relevant scientific questions.However, interest in developing normalised procedures has been growing over the last few years. A good example is the 2002 Pittsburgh consensus meeting organised by the American Speech-Language-Hearing Association's Division 3; in this meeting, the bases were established for the initial version of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V), whose adaptation to Spanish was an objective of this study.The CAPE-V evaluation method CAPE-V is the result of the efforts of the American Speech-Language-Hearing Association to create a clinical protocol that could be used to make standardised auditory-perceptual judgements on vocal quality. The procedures included in the CAPE-V represent the recommendations reached by consensus among experts in human perception, scientists working on speaking and vocal studies and speech-language pathologists specialised in voice problems. Although there is no ideal method for obtaining a valid, reliable rating of vocal quality, the CAPE-V method stems from the most up-to-date knowledge about the multidimensional factors on which psychophysical measurement of human perception is based.The authors that describe the CAPE-V hope that it will serve as a foundation and a stimulus to improve clinical practice in the field of auditory-perceptual voice evaluation.This work was based on this objective, and aimed at the adaptation of the CAPE-V method to Spanish with a clinical validation afterwards, so it could be used with Spanish-speaking patients.Material and MethodsDescription of the CAPE-V MethodThis method rates important vocal attributes that the consensus work group members<a class="elsevierStyleCrossRef" href="#bib0130">1</a> identified as commonly used and easily understood. These attributes are: (a) overall severity, (b) roughness, (c) breathiness, (d) strain, (e) pitch and (f) loudness. The CAPE-V weights each attribute using a 100-mm line as a visual-analogue scale. The observer indicates the degree of perceived deviance from normal on this scale by making a tick mark on the line. The ratings are established by direct observation of vocal output, not by patient report or other means. The 6 attributes described above have to be considered as the minimums that are to be evaluated using this method.<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">(a)Recording. The patient is seated comfortably in a quiet environment to record the 3 vocal tasks that the patient is to complete: an isolated vowel, repetition of sentences and a spontaneous natural conversation sample. The following standard recording procedures are to be used: use a condenser microphone placed 45° azimuth from the front of the mouth and 4cm away from it. A computer with 16 bits of resolution and frequency-sampling rate no less than 20kHz is recommended.Task 1. Sustained vowels. Two vowels are used for this task: a lax or open vowel like the /a/ and a tense vowel like the /i/. The patient is instructed to produce a comfortable emission of the /a/, using his/her normal voice and prolonging it until indicated to stop. An example may be necessary. This is performed 3 times, for 3–5s each time. The task is then repeated with the vowel /i/. This task provides the opportunity to listen to the patient's voice without the influence of speaking. These vowels can also be analysed acoustically.Task 2. Sentences. There are 6 sentences designed to cause various laryngeal behaviours and clinical signs. The first sentence produces all the vowel sounds in the English language, and is useful for studying the coarticulatory influences of the 3 vowels /a, i, u/. The second sentence emphasises the easy glottic closing that happens with words beginning with /h/. The third is completely voiced; it offers the context in which to judge the presence of vocal spasms or interruptions and the subject's ability to link words maintaining vocalisation. The fourth sentence brings forth hard glottal attack. The fifth incorporates nasal sounds, which serve to detect possible hyponasality. Finally, the sixth sentence is balanced with voiced plosive consonants; this helps to evaluate intraoral pressure and possible hypernasality and nasal air emission. The patient is given a card for each sentence, which should be read silently and then out loud. If the patient has difficulty in reading, he/she should repeat the phrase said to him/her. The original sentences in English are: (a) The blue spot is on the key again; (b) How hard did he hit him; (c) We were away a year ago; (d) We eat eggs every Easter; (e) My mama makes lemon jam; and (f) Peter will keep at the peak. The phonetic adaptation to Spanish is presented in the following section.Task 3. Spontaneous speech. At least 20s of natural conversation are recorded, using standard interview questions such as “Tell me about your voice problem” or “Tell me how your voice is functioning”.</li><li class="elsevierStyleListItem" id="lsti0010">(b)Scoring. Recording the 3 voice tasks must be finished before beginning the scoring process. Only 1 form is filled out for each patient (Annex 1). The tasks should be numbered if they are to be rated differently (1 for a sustained vowel, 2 for the sentences and 3 for the natural conversation). Once scored, the scales are measured physically from the left end to the point marked, indicating the millimetres left with reference to the total (for example, 73/100mm).</li></ul>Phonetic Adaptation of the CAPE-V to SpanishThis process was not merely an English–Spanish translation. An adaptation and sentence change was required, given that the literal translation of these sentences into Castilian Spanish would make it impossible to evaluate the voice quality elements desired.To design the new sentences, the phonetic context to be evaluated in each case was considered. For this adaptation, a speech therapist (AAM) assessed the work. The 6 sentences proposed for adapting the CAPE-V method to Spanish were as follows:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0015">(a)Sentence 1. This is designed to study the coarticulatory influence of the various vowels. Original sentence in English: “The blue spot is on the key again”. Adapted sentence for this study: “Nuria ojeó una pajarita and una blusa amarillas” [Nuria glanced at a small bird and a yellow blouse].</li><li class="elsevierStyleListItem" id="lsti0020">(b)Sentence 2. This offers appropriate context to evaluate the production of soft glottic attacks and transitions from voiceless to voiced. Original sentence in English: “How hard did he hit him”. Adapted sentence for this study: “Marta multa mi moto más mágica” [Martha gave a fine to my most magical motorcycle].</li><li class="elsevierStyleListItem" id="lsti0025">(c)Sentence 3. It produces all the voiced phonemes and creates appropriate context for judging the possible existence of spasms/detentions and patient ability to link a word with the next (maintaining vocalisation). Original sentence in English: “We were away a year ago”. Adapted sentence for this study: “La llave brilla en la mano” [The key shines in the hand].</li><li class="elsevierStyleListItem" id="lsti0030">(d)Sentence 4. It includes many words that begin with a vowel and can provoke hard glottic attacks, providing the chance to see if these occur in the patient. Original sentence in English: “We eat eggs every Easter”. Adapted sentence for this study: “Irene adora hacer huevos al horno” [Irene adores making eggs in the oven].</li><li class="elsevierStyleListItem" id="lsti0035">(e)Sentence 5. It includes numerous nasal consonants, providing the opportunity of evaluating hyponasality and seeing whether stimulation by resonant voice therapy is possible. Original sentence in English: “My mama makes lemon jam”. Adapted sentence for this study: “Mamá me mima una mano” [Mama massages my hand].</li><li class="elsevierStyleListItem" id="lsti0040">(f)Sentence 6. It has a total lack of nasal consonants and creates a useful context for evaluating intraoral pressure and seeing if there is hypernasality and nasal air emission. Original sentence in English: “Peter will keep at the peak”. Adapted sentence for this study: “Ata tu zapato a tu pata” [Tie your shoe to your leg].</li></ul>ParticipantsIn all, 67 people participated in this study: 31 men and 36 women. Their ages ranged between 21 and 80 years, with a mean of 46 years.These 67 individuals were divided into 2 groups: the first consisted of 50 subjects with dysphonia (24 women and 26 men), while the second consisted of 17 healthy subjects (12 women, 5 men). The subjects with dysphonia that participated in the study were recruited from the patients that came to outpatient consultation service in the Ear, Nose and Throat Service at the Hospital Universitario Central de Asturias between July 2013 and March 2014. All the patients agreed to participate in the study after it was explained to them; they gave express verbal consent to use their voices in the study. The group of healthy subjects was composed of volunteers from the hospital environment (hospital residents and nurses, as well friends) that agreed to participate in the study and that did not present any of the following criteria for exclusion: be a minor, or be or have been diagnosed with any laryngeal pathology. Within the group of patients with voice disorders, a subgroup of 22 patients (12 women and 10 men) was created; all these patients had undergone a surgical treatment using direct microlaryngoscopy to remove the tumour-type lesion that they presented. This patient subgroup was very homogeneous in the type of dysphonia presented and in the change expected following the intervention. Each of these patients had 2 recordings: 1 made preoperatively and another made after the intervention (not before 2 months following the operation). Both samples were randomised and classified independently. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> presents a summary of the patient diagnoses.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Auditory-Perceptual Evaluation of the Voice Samples (GRBAS and CAPE-V)Auditory-perceptual analysis of the voice samples was performed by 2 specialists familiar with both methods. The voice series to be rated was stored in 2 randomly determined different sequences. Observer 1 rated the entire series with the grade-roughness-breathiness-asthenicity-strain (GRBAS) method, listening exclusively to the sustained vowel. Seven days later, this observer rated the same series using the CAPE-V method, this time listening to all the recorded tasks. Observer 2 only performed the CAPE-V scoring. For the rating, the observers played back the voices in a quiet environment, listening with the computer loudspeakers or headphones in blocks of 20, with a 10-min rest period between the consecutive blocks. Although both examiners were experienced in auditory-perceptual voice analysis, they received 2 pattern voice scales that were constructed using a spectrographic visual aid for breathy and rough voices.<a class="elsevierStyleCrossRef" href="#bib0135">2</a> After listening to each voice, the observer rated it without sharing information with the other observer; they could listen to the voices again as many times as necessary. The observers did not know the patients’ diagnoses, nor the fact that normal voices were included among those of the patients, because that could compromise rating reliability.<a class="elsevierStyleCrossRef" href="#bib0140">3</a>Statistical StudyThe statistical analysis application SPSS 18 (PASW Statistics 18) was used for the statistical study. Data analysis consisted of determining the following:<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0045">(a)Reliability (fiabilidad) or consistence: the degree with which an instrument measures with precision.<a class="elsevierStyleCrossRef" href="#bib0145">4</a> Within this section, intraobserver and interobserver consistence are distinguished.</li><li class="elsevierStyleListItem" id="lsti0050">(b)Test–retest reliability, repeatability or intraobserver consistence: this measures the stability of the scores given by the same evaluator for the same subjects and using the same method at different times; in contrast, interobserver reliability consists of estimating the degree of agreement between 2 or more evaluators.</li><li class="elsevierStyleListItem" id="lsti0055">(c)Analysing the validity of the CAPE-V protocol: this is define as the capacity of an instrument to measure that for which it has been designed.<a class="elsevierStyleCrossRef" href="#bib0150">5</a> The validity prototype for the analysis of diagnostic tests is the validity of criteria. This is calculated by comparing the new measuring instrument with another already demonstrated validity, which is to serve as a reference for the phenomenon under study. The external criteria method should be an independent measurement obtained by a different method, in which the results of the questionnaire to be validated do not intervene. In our study we used the GRBAS scale as the reference, because it is an extensively used, already-validated scale. The statistics used to evaluate the previously described voice tasks is the intraclass correlation coefficient (ICC), which makes it possible to evaluate the level of agreement between 2 measurements.</li><li class="elsevierStyleListItem" id="lsti0060">(d)Sensitivity to change of the validated instrument was also determined: this can be defined as the capacity of an instrument to detect changes in the sample after applying a treatment. Student's t-test was used as a statistic, assuming that the null hypothesis is the absence of change in the mean response in a sample at 2 different moments.<a class="elsevierStyleCrossRef" href="#bib0150">5</a></li></ul>ResultsInterobserver ReliabilityThis factor evaluates the level of agreement between the 2 observers and is expressed through the ICC with a double randomised affect, where both the vocal samples and the observer are considered random. <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> presents the results for each of the 6 CAPE-V parameters, differentiated through the various tasks evaluated. The results fluctuate between 0.93 for general severity in Task 1 and 0.54 for loudness in Task 2. In general, Task 1 shows higher concordance values than the rest of the tasks. The most consistent parameters evaluated are general severity, roughness and breathiness, respectively (ICC>0.750), while strain and loudness are the least consistent parameters (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Intraobserver ReliabilityThis reflects the consistence of the 50 ratings given by the same observer at 2 different times. As can be seen in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>, very high levels of reliability were reached for all the CAPE-V parameters (ICC>0.850). The best results were obtained for the parameters of Task 1, reflecting our evaluator's greater experience of in rating vowels. This does not mean there is any reason why the results obtained in the rest of the tasks do not have robust concordance.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>Validity of Criteria Between GRBAS and CAPE-VThe degree of agreement between the 2 protocols is expressed through the ICC and correlates a continuous variable based on a visual analogue scale of 100mm such as the CAPE-V with another ordinal variable having 4 categories (GRBAS). <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> shows the correlation between homologous parameters in the different scales. Task 1 obtains the best correlation results for all the items. General severity, as an CAPE-V with the one that has the most consistence and the highest level of agreement (average ICC: 0.865). However, breathiness is the parameter that shows the worst correlation (average ICC: 0.612); this is fundamentally due to the poor results obtained with Task 2 (ICC: 0.133). The parameters roughness and strain show good correlation with the 2 scales.<elsevierMultimedia ident="tbl0020"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#fig0010">Fig. 1</a> shows the correlation between the ratings on the different scales for general severity.<elsevierMultimedia ident="fig0010"></elsevierMultimedia>Sensitivity to ChangeThe existence of significant differences among the average rating values for each item was analysed. The postoperative results analysed showed significant difference for general severity with both tests used (<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>). In contrast, for the rest of the items studied, the CAPE-V detected significant differences, while the GRBAS did not detect any differences. None of the tests detected differences for the strain parameter (<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>).<elsevierMultimedia ident="tbl0025"></elsevierMultimedia><elsevierMultimedia ident="tbl0030"></elsevierMultimedia>DiscussionPerceptual evaluation is an essential method for assessing the pathological voice. This is because it is necessary to apply it in a large number of patients in which the measurements of short-term perturbation are not reliable or they cannot be calculated.<a class="elsevierStyleCrossRef" href="#bib0155">6</a>Despite the fact that voice perception is the primary tool for judging if there is an alteration in the voice, the methods that rate vocal quality can never be carried out with perfect validity and reliability. Various methods have been described to perform this perceptual evaluation of the voice consistently and in a clinically useful way.At present, no method has shown that it is better than the others in the task of measuring perceived vocal quality. Current knowledge is still inadequate for designing a clinical instrument that could resolve all the relevant scientific matters. In fact, the efforts to achieve this have been accompanied by countless problems related to reliability, usefulness and validity. However, there are attempts to develop protocols to document the auditory-perceptual characteristics of alterations in voice quality. Constructing a consistent, specific procedure with a documented format has served to provide these methods with clinical consistence and to improve communication among the clinicians.The studies performed to date do not support substituting instrumental means with auditory-perceptual evaluation. To have clinical consideration, however, perceptual evaluation has to follow a standard procedure. At present, the 2 methods most used that provide a standard protocol are the GRBAS and CAPE-V methods.<a class="elsevierStyleCrossRef" href="#bib0160">7</a>Bearing all this in mind, creating an “ideal” method of vocal evaluation has been attempted. This method would propose consistent protocols to differentiate normal voices from pathological ones. It would also correlate with objective measurements and the underlying physiopathology.The psychoacoustic sensation of the voice is the main tool in evaluating voice disorders, both for the patients when they explain the change that they notice in their voices, and for the clinicians when describing such changes.<a class="elsevierStyleCrossRefs" href="#bib0165">8–11</a> The auditory-perceptual measurements of vocal quality define the presence or absence of clinical alterations at the laryngeal level. The reason for this is that the continuum between the normal voice and the pathological voice is closely related with vocal health. Specialists in phonology describe vocal alterations through their own perceptual judgements, judgements based on their experience, social and cultural factors and the environment in which they work.However, auditory-perceptual voice rating will never be performed with perfect validity or reliability, because these are subjective methods.<a class="elsevierStyleCrossRefs" href="#bib0185">12,13</a> This is a controversial subject because the evaluators do not have specific training and there is also a wide variability in inter- and intra-evaluator correlation. Experienced observers have been shown to judge more consistently than non-experts do and to use perceptually different strategies; it has been demonstrated that 8h of training for previously inexperienced observers are enough to obtain interobserver reliability of 80%.<a class="elsevierStyleCrossRef" href="#bib0155">6</a> It has also been confirmed that homogeneity of criteria when applying the questionnaire improves consistency among the various observers.<a class="elsevierStyleCrossRef" href="#bib0195">14</a>That is why there is a clear need to create a protocol so that these evaluations are carried out in a more theoretical, clinically significant and consistent manner. The method that comes closest to this focus is the CAPE-V, given that it describes a precise protocol for performing the perceptual evaluation as consistently as possible. However, applying it to the Spanish language is impossible without carrying out an adaptation of the task that analyses connected speech in pre-established sentences (Task 2). This served as the motivation for this study covering the adaptation and validation of the CAPE-V protocol to Spanish.Our work began with adapting the sentences in English from the original document to the Spanish language. This was a task that had not been achieved up until now, making the use of the CAPE-V impossible in our environment. A mere translation of the sentences in Task 2 of the protocol would not be enough and would lack any sense; consequently, we proposed sentences in Spanish that fulfil the phonetic characteristics of those designed in the original language, English. The original sentences have been linguistically adapted, based on the phonetic description included in the original article on the CAPE-V.<a class="elsevierStyleCrossRef" href="#bib0130">1</a>These sentences reveal delicate phonetic situations that help us to detect specific types of vocal alterations related to the capacity for resonance of the voice tract or to the capacity for vocal articulation that cannot be evaluated by the study of sustained vowels, but which make it possible to complete the rating.Once the sentences had been adapted into Spanish, the next step was to validate the CAPE-V as a useful, reliable tool for perceptual voice evaluation; the instrument had to reflect the relevant vocal characteristics of the human voice, that is, to demonstrate the validity of the construct. The attempt was to achieve a protocol for overall voice evaluation that was complete and universally validated by the specialists. To accomplish this last step the protocol needed to be adapted and implemented in Spanish-speaking countries, which had not been achieved up until now. This study is based on the validation study of the original CAPE-V protocol published by Zraick et al.<a class="elsevierStyleCrossRef" href="#bib0200">15</a> on 74 vocal samples (among which 37 were dysphonic, 22 corresponded to healthy control voices, 11 were repeated samples and 4 were training voices).In contrast to the GRBAS system and other evaluation protocols, the CAPE-V incorporates pitch and loudness into routine vocal evaluation. These parameters are absent from many of the perceptual voice evaluation instruments (for example, the GRBAS) and comparisons of results is consequently limited in the literature.<a class="elsevierStyleCrossRef" href="#bib0205">16</a> The few articles in which they are included show that they are inconsistent parameters that present a lot of inter- and intraobserver variability.<a class="elsevierStyleCrossRef" href="#bib0200">15</a>The use of connected speech in the form of sentences or spontaneous conversation in the CAPE-V method is the most important difference from the GRBAS method, which only uses sustained vowels. This aspect deserves our attention, as we have found differences among ratings with vowels or connected speech. Other authors had already indicated this. An example is the study of Zraick et al.<a class="elsevierStyleCrossRef" href="#bib0200">15</a> in their evaluation of vocal samples by means of sustained vowels, natural conversation and connected voice, establishing that there are significant differences between the first vocal task and the second: the most severe ratings were obtained with sustained vowels. They did not find significant differences between the 2 tasks insofar as connected speech: natural conversation and reading a literary pasaje.<a class="elsevierStyleCrossRef" href="#bib0210">17</a> These findings are also in agreement with the studies by Wolfe et al.<a class="elsevierStyleCrossRef" href="#bib0215">18</a> There are many publications studying the comparison between both phonation tasks, but no consensus has been reached.<a class="elsevierStyleCrossRefs" href="#bib0220">19,20</a> Despite all this and with the aim of simplification, it is not unusual to find articles that adapt the well-structured methodology of the CAPE-V to avoid evaluating the 3 vocal tasks and thus simplify the results; this is the case of the Kelchner study<a class="elsevierStyleCrossRef" href="#bib0230">21</a> in a paediatric population, that uses only Task 2 for vocal rating. In our study, we find results that are very similar to those published by Zraick et al.<a class="elsevierStyleCrossRef" href="#bib0200">15</a>We carried out a comparison between our evaluation using the CAPE-V with the one obtained using the GRBAS system, the current “gold standard”. In this comparison, we found significant differences between the ratings in Task 1 and the ratings in Tasks 2 and 3. As is to be expected, the tasks corresponding to connected speech have a similar behaviour and the levels of agreement are above 0.94 for all the parameters evaluated. With respect to Task 1, significant differences are found compared to Tasks 2 and 3, but they do not condition disagreement with the previous evaluations, maintaining a degree of concordance above 0.85.Insofar as validity of criteria, the results obtained for Task 1 are similar to those obtained with the GRBAS method, ensuring a very high level of agreement between the 2 tests. However, the results from Tasks 2 and 3 reflect lesser influence in the severity of voice as compared with Task 1 and this reduces the level of agreement in relation to the GRBAS. In this last case, the strength of concordance is lower than that obtained for the previously mentioned vowel phonation, although it remains at intermediate/high levels. We should mention the behaviour of the Task 2 results obtained by the phonetically adapted sentences, which reflect the worst level of agreement with the GRBAS of the 3 tasks assessed. This might be due to the penalisation attributable to the directed phonetic context that strengthens the vowel alterations of the samples, causing sudden glottic attacks, voiceless-voiced transitions, etc.Separating the results by parameters, general severity obtains the best results. Roughness, breathiness and strain reflect good correlation between the CAPE-V and GRBAS, but with less strength than general severity. The exception is breathiness in Task 2, which achieves a very low level of agreement; this could be explained because the linguistic context strengthens the escape of air during phonation.The intraobserver consistency detected in our study is very high, in all the tasks and for all the parameters. The correlations are higher than 90% in all the cases, findings that are similar to those in previous studies.<a class="elsevierStyleCrossRefs" href="#bib0200">15,16</a>As for interobserver reliability in our study, it has variable ranges from which we can reach several conclusions. The most consistent parameters are general severity, roughness and breathiness. These parameters, regardless of the task, acquire high values and reflect good reliability or consistency. The rest (loudness, pitch and strain) show variable figures in the range of intermediate consistency. In the light of data published in the literature, these are conclusions confirmed by other authors: severity, roughness and breathiness are parameters of demonstrated consistency. Loudness and pitch are items that are hard to rate because of the difficulties in defining and quantifying their alterations.<a class="elsevierStyleCrossRefs" href="#bib0235">22–25</a>Authors such as Karnell<a class="elsevierStyleCrossRef" href="#bib0195">14</a> have published studies on interobserver consistency with results similar to those of our series. This suggests that the CAPE-V protocol is more sensitive to small rating differences than the GRBAS scale. This characteristic is also emphasised in the Zraick et al. publication,<a class="elsevierStyleCrossRef" href="#bib0200">15</a> defending better CAPE-V results in consistency compared with the GRBAS.With respect to sensitivity to change, significant differences in the 2 protocols were only found in general severity. This could be due to the high consistency of the parameter, with it being the one that had the greatest overall influence after vocal fold treatment. For the rest, significant differences were only seen with the CAPE-V in roughness, breathiness, loudness and pitch.Consequently, the CAPE-V protocol in the Spanish language would stand validated, with its concordance with the results obtained with the current reference criteria, which is the GRBAS. It is important to indicate that the CAPE-V method provides a greater wealth of information in perceptual rating, given that it offers an overall voice quality evaluation, widening and completing the rating of sustained vowels.Conclusions<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0065">1.The adaptation of the CAPE-V system to Spanish that is proposed can be considered validated by the results of this study.</li><li class="elsevierStyleListItem" id="lsti0070">2.The perceptual evaluation of the phonetically adapted sentences reflects the worst level of agreement with perceptual evaluation using the GRBAS scale system (sustained vowels). For this reason, the CAPE-V method provides greater richness in perceptual rating, given that it offers an overall evaluation of voice quality, extending and completing it.</li><li class="elsevierStyleListItem" id="lsti0075">3.Comparing the ratings obtained using the CAPE-V method with the GRBAS scale (gold standard), general severity is the parameter that obtains the best results. Roughness, breathiness and strain reflect good correlation between the CAPE-V and the GRBAS, but less robustly than with the former.</li></ul>Conflict of InterestsThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres562517" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec579104" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres562518" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec579103" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and Methods" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Description of the CAPE-V Method" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Phonetic Adaptation of the CAPE-V to Spanish" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Participants" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Auditory-Perceptual Evaluation of the Voice Samples (GRBAS and CAPE-V)" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Statistical Study" ] ] ] 6 => array:3 [ "identificador" => "sec0040" "titulo" => "Results" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0045" "titulo" => "Interobserver Reliability" ] 1 => array:2 [ "identificador" => "sec0050" "titulo" => "Intraobserver Reliability" ] 2 => array:2 [ "identificador" => "sec0055" "titulo" => "Validity of Criteria Between GRBAS and CAPE-V" ] 3 => array:2 [ "identificador" => "sec0060" "titulo" => "Sensitivity to Change" ] ] ] 7 => array:2 [ "identificador" => "sec0065" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0070" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0075" "titulo" => "Conflict of Interests" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-07-22" "fechaAceptado" => "2014-07-30" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec579104" "palabras" => array:3 [ 0 => "Voice disorders" 1 => "Voice analysis" 2 => "Voice perceptual analysis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec579103" "palabras" => array:3 [ 0 => "Trastornos vocales" 1 => "Análisis de la voz" 2 => "Análisis perceptual de la voz" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveThe Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) was developed to promote a standardised approach to evaluating and documenting auditory perceptual judgments of vocal quality. This tool was originally developed in English language and its Spanish version is still inexistent. The aim of this study was to develop a Spanish adaptation of CAPE-V and to examine the reliability and empirical validity of this Spanish version. MethodTo adapt the CAPE-V protocol to the Spanish language, we proposed 6 phrases phonetically designed according to the CAPE-V requirements. Prospective instrument validation was performed. The validity of the Spanish version of the CAPE-V was examined in 4 ways: intra-rater reliability, inter-rater reliability and CAPE-V versus GRABS judgments. ResultsInter-rater reliability coefficients for the CAPE-V ranged from 0.93 for overall severity to 0.54 for intensity; intra-rater reliability ranged from 0.98 for overall severity to 0.85 for intensity. The comparison of judgments between GRABS and CAPE-V ranged from 0.86 for overall severity to 0.61 for breathiness. ConclusionsThe present study supports the use of the Spanish version of CAPE-V because of its validity and reliability." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivoCon el propósito de promocionar un abordaje estándar para la evaluación y documentación de las calificaciones perceptuales de la calidad vocal se desarrolló el método CAPE-V (Consensus Auditory-Perceptual Evaluation of Voice). Originalmente diseñado en el idioma inglés, no existe una adaptación del mismo para ser usado en hispanohablantes. El propósito del presente trabajo es proponer una adaptación del protocolo al español y examinar la fiabilidad y la validez empírica de dicha versión. MétodoCon el fin de adaptar el protocolo al español, se proponen seis frases de acuerdo a los requerimientos fonéticos del CAPE-V. Se llevó a cabo una validación instrumental de forma prospectiva. La validez de la versión en español del CAPE-V se investigó mediante la determinación de la fiabilidad intra- e interobservador y mediante la comparación de las calificaciones obtenidas mediante el CAPE-V con las obtenidas mediante el GRABS. ResultadosLos coeficientes de fiabilidad interobservador fluctuaron entre el 0,93 para la severidad global y el 0,54 para la intensidad, mientras que la fiabilidad intraobservador varió entre el 0,98 para la severidad global y el 0,85 para la intensidad. La comparación entre las calificaciones obtenidas mediante el método GRABS y el CAPE-V obtuvo resultados entre el 0,86 para la severidad global y el 0,61 para la calidad aérea. ConclusionesEl presente estudio apoya el uso de la versión en español del CAPE-V dada su validez y fiabilidad." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Núñez-Batalla F, Morato-Galán M, García-López I, Ávila-Menéndez A. Adaptación fonética y validación del método de valoración perceptual de la voz CAPE-V al español. Acta Otorrinolaringol Esp. 2015;66:249–257." ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<elsevierMultimedia ident="fig0005"></elsevierMultimedia>" "etiqueta" => "Annex 1" "titulo" => "Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V)" "identificador" => "sec0080" ] ] ] ] "multimedia" => array:8 [ 0 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1311 "Ancho" => 1626 "Tamanyo" => 50969 ] ] "descripcion" => array:1 [ "en" => "Concordance of general severity between the CAPE-V and GRBAS." ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pathology \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No. \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patients operated on \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Vocal polyp \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">New laryngeal vessels \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Reinke's oedema \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Subepithelial cysts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Nodules \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Serous pseudocyst \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Leukoplakia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Idiopathic vocal paralysis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Posterior third granuloma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Laryngeal papillomatosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab911643.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Diagnoses of the Entire Patient Group and of the Subgroup Operated Surgically." ] ] 2 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Parameter \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Task 1 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Task 2 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Task 3 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">General severity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.935 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.879 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.833 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Roughness \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.907 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.775 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.750 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Breathiness \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.894 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.773 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.769 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Strain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.648 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.698 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.738 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Pitch \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.795 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.710 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.806 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Loudness \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.763 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.545 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.617 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab911640.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Interobserver CAPE-V Consistency." ] ] 3 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Parameter \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Task 1 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Task 2 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Task 3 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">General severity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.988 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.972 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.978 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Roughness \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.981 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.969 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.972 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Breathiness \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.979 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.968 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.952 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Strain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.971 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.921 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.935 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Pitch \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.963 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.918 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.894 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Loudness \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.961 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.895 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.851 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab911642.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Intraobserver CAPE-V Consistency." ] ] 4 => array:7 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CAPE versus GRBAS \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Task 1 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Task 2 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Task 3 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Average ICC \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">General severity – grade \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.965 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.789 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.866 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.874 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Roughness – roughness \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.950 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.755 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.842 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.849 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Breathiness – breathiness \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.961 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.133 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.742 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.612 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Strain – strain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.912 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.819 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.799 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.843 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab911638.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Level of Agreement Between GRBAS and CAPE-V Results." ] ] 5 => array:7 [ "identificador" => "tbl0025" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">General severity \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Means \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Grade \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Means \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Difference of means</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Significance \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Pre \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68.86 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pre \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">General severity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.727 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Post \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41.14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pos \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.68 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Grade \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.682 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.004 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab911639.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Sensitivity to General Severity Change." ] ] 6 => array:7 [ "identificador" => "tbl0030" "etiqueta" => "Table 6" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col">Tasks 1, 2 and 3 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Level of significance of the differences</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CAPE-V \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">GRBAS \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">General severity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.004 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Roughness \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.002 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.007 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Breathiness \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.038 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Strain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.044 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.090 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab911641.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Sensitivity to CAPE-V and GRBAS Change." ] ] 7 => array:5 [ "identificador" => "fig0005" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx1.jpeg" "Alto" => 3935 "Ancho" => 2187 "Tamanyo" => 501857 ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:25 [ 0 => array:3 [ "identificador" => "bib0130" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Consensus auditory perceptual evaluation of voice: development of a standardized clinical protocol" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "G.B. Kempster" 1 => "B.R. Gerratt" 2 => "K. Verdolini Abbott" 3 => "J. Barkmeier-Kramer" 4 => "R.E. Hillman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1044/1058-0360(2008/08-0017)" "Revista" => array:6 [ "tituloSerie" => "Am J Speech Lang Pathol" "fecha" => "2009" "volumen" => "18" "paginaInicial" => "124" "paginaFinal" => "132" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18930908" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0135" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "El espectrograma de banda estrecha como ayuda para el aprendizaje del método GRABS de análisis perceptual de la disfonía" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Núñez-Batalla" 1 => "J.P. Díaz-Molina" 2 => "I. García-López" 3 => "A. Moreno-Méndez" 4 => "M. Costales-Marcos" 5 => "C. 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Validation of the Spanish Adaptation of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V)

Adaptación fonética y validación del método de valoración perceptual de la voz CAPE-V al español

Faustino Núñez-Batallaa,

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fnunezb@telefonica.net

Corresponding author.

, Marta Morato-Galána, Isabel García-Lópezb, Arántzazu Ávila-Menéndezc

a Servicio de Otorrinolaringología, Hospital Universitario Central de Asturias, Oviedo, Spain

b Servicio de Otorrinolaringología, Hospital Universitario La Paz, Madrid, Spain

c Logopedia, Facultad de Psicología, Universidad de Oviedo, Oviedo, Spain

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Conceptually&#44; the &#8220;ideal&#8221; method for carrying out auditory-perceptual voice assessment should fulfil the following conditions&#58; analyse consistent vocal qualities that make it possible to clearly differentiate the normal voice from the pathological voice and compare its changes over time&#44; maintain a specific correlation between the underlying physiopathology and the objective evaluation parameters&#44; clearly specify the type of scale used in assessment&#44; and describe the specific training of the observer&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">However&#44; there are important obstacles that prevent any appraisal method from fulfilling these ideal conditions&#46; The first is that no specific&#44; standardised terminology that makes it possible to describe the type of voice alteration or stratify its severity exists&#46; Standard parameters that define the normal voice are missing as well&#46; Finally&#44; and most important&#44; there is little consistency&#44; a matter that is inherent in all auditory-perceptual evaluations&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Until now&#44; perceptual judgement of the voice has been an uncertain task&#44; marked by disagreements among phonology experts and variability in gathering and presenting data&#46; Until now&#44; no method has been shown to be better than others in measuring perceived vocal quality&#46; Likewise&#44; current knowledge is still considered inadequate for designing a clinical tool that could resolve all the relevant scientific questions&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">However&#44; interest in developing normalised procedures has been growing over the last few years&#46; A good example is the 2002 Pittsburgh consensus meeting organised by the American Speech-Language-Hearing Association&#39;s Division 3&#59; in this meeting&#44; the bases were established for the initial version of the Consensus Auditory-Perceptual Evaluation of Voice &#40;CAPE-V&#41;&#44; whose adaptation to Spanish was an objective of this study&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The CAPE-V evaluation method CAPE-V is the result of the efforts of the American Speech-Language-Hearing Association to create a clinical protocol that could be used to make standardised auditory-perceptual judgements on vocal quality&#46; The procedures included in the CAPE-V represent the recommendations reached by consensus among experts in human perception&#44; scientists working on speaking and vocal studies and speech-language pathologists specialised in voice problems&#46; Although there is no ideal method for obtaining a valid&#44; reliable rating of vocal quality&#44; 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The following standard recording procedures are to be used&#58; use a condenser microphone placed 45&#176; azimuth from the front of the mouth and 4<span class="elsevierStyleHsp" style=""></span>cm away from it&#46; A computer with 16 bits of resolution and frequency-sampling rate no less than 20<span class="elsevierStyleHsp" style=""></span>kHz is recommended&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Task 1&#46; Sustained vowels&#46; Two vowels are used for this task&#58; a lax or open vowel like the &#47;a&#47; and a tense vowel like the &#47;i&#47;&#46; The patient is instructed to produce a comfortable emission of the &#47;a&#47;&#44; using his&#47;her normal voice and prolonging it until indicated to stop&#46; An example may be necessary&#46; This is performed 3 times&#44; for 3&#8211;5<span class="elsevierStyleHsp" style=""></span>s each time&#46; The task is then repeated with the vowel &#47;i&#47;&#46; This task provides the opportunity to listen to the patient&#39;s voice without the influence of speaking&#46; 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The patient is given a card for each sentence&#44; which should be read silently and then out loud&#46; If the patient has difficulty in reading&#44; he&#47;she should repeat the phrase said to him&#47;her&#46; The original sentences in English are&#58; &#40;a&#41; <span class="elsevierStyleItalic">The blue spot is on the key again</span>&#59; &#40;b&#41; <span class="elsevierStyleItalic">How hard did he hit him</span>&#59; &#40;c&#41; <span class="elsevierStyleItalic">We were away a year ago</span>&#59; &#40;d&#41; <span class="elsevierStyleItalic">We eat eggs every Easter</span>&#59; &#40;e&#41; <span class="elsevierStyleItalic">My mama makes lemon jam</span>&#59; and &#40;f&#41; <span class="elsevierStyleItalic">Peter will keep at the peak</span>&#46; The phonetic adaptation to Spanish is presented in the following section&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Task 3&#46; Spontaneous speech&#46; At least 20<span class="elsevierStyleHsp" style=""></span>s of natural conversation are recorded&#44; 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Original sentence in English&#58; &#8220;We were away a year ago&#8221;&#46; Adapted sentence for this study&#58; &#8220;<span class="elsevierStyleItalic">La llave brilla en la mano</span>&#8221; &#91;The key shines in the hand&#93;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#40;d&#41;</span><p id="par0095" class="elsevierStylePara elsevierViewall">Sentence 4&#46; It includes many words that begin with a vowel and can provoke hard glottic attacks&#44; providing the chance to see if these occur in the patient&#46; Original sentence in English&#58; &#8220;We eat eggs every Easter&#8221;&#46; Adapted sentence for this study&#58; &#8220;<span class="elsevierStyleItalic">Irene adora hacer huevos al horno</span>&#8221; &#91;Irene adores making eggs in the oven&#93;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">&#40;e&#41;</span><p id="par0100" class="elsevierStylePara elsevierViewall">Sentence 5&#46; It includes numerous nasal consonants&#44; providing the opportunity of evaluating hyponasality and seeing whether stimulation by resonant voice therapy is possible&#46; Original sentence in English&#58; &#8220;My mama makes lemon jam&#8221;&#46; Adapted sentence for this study&#58; &#8220;<span class="elsevierStyleItalic">Mam&#225; me mima una mano</span>&#8221; &#91;Mama massages my hand&#93;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">&#40;f&#41;</span><p id="par0105" class="elsevierStylePara elsevierViewall">Sentence 6&#46; It has a total lack of nasal consonants and creates a useful context for evaluating intraoral pressure and seeing if there is hypernasality and nasal air emission&#46; Original sentence in English&#58; &#8220;Peter will keep at the peak&#8221;&#46; Adapted sentence for this study&#58; &#8220;<span class="elsevierStyleItalic">Ata tu zapato a tu pata</span>&#8221; &#91;Tie your shoe to your leg&#93;&#46;</p></li></ul></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Participants</span><p id="par0110" class="elsevierStylePara elsevierViewall">In all&#44; 67 people participated in this study&#58; 31 men and 36 women&#46; Their ages ranged between 21 and 80 years&#44; with a mean of 46 years&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">These 67 individuals were divided into 2 groups&#58; the first consisted of 50 subjects with dysphonia &#40;24 women and 26 men&#41;&#44; while the second consisted of 17 healthy subjects &#40;12 women&#44; 5 men&#41;&#46; The subjects with dysphonia that participated in the study were recruited from the patients that came to outpatient consultation service in the Ear&#44; Nose and Throat Service at the Hospital Universitario Central de Asturias between July 2013 and March 2014&#46; All the patients agreed to participate in the study after it was explained to them&#59; they gave express verbal consent to use their voices in the study&#46; The group of healthy subjects was composed of volunteers from the hospital environment &#40;hospital residents and nurses&#44; as well friends&#41; that agreed to participate in the study and that did not present any of the following criteria for exclusion&#58; be a minor&#44; or be or have been diagnosed with any laryngeal pathology&#46; Within the group of patients with voice disorders&#44; a subgroup of 22 patients &#40;12 women and 10 men&#41; was created&#59; all these patients had undergone a surgical treatment using direct microlaryngoscopy to remove the tumour-type lesion that they presented&#46; This patient subgroup was very homogeneous in the type of dysphonia presented and in the change expected following the intervention&#46; Each of these patients had 2 recordings&#58; 1 made preoperatively and another made after the intervention &#40;not before 2 months following the operation&#41;&#46; Both samples were randomised and classified independently&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> presents a summary of the patient diagnoses&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Auditory-Perceptual Evaluation of the Voice Samples &#40;GRBAS and CAPE-V&#41;</span><p id="par0120" class="elsevierStylePara elsevierViewall">Auditory-perceptual analysis of the voice samples was performed by 2 specialists familiar with both methods&#46; The voice series to be rated was stored in 2 randomly determined different sequences&#46; Observer 1 rated the entire series with the grade-roughness-breathiness-asthenicity-strain &#40;GRBAS&#41; method&#44; listening exclusively to the sustained vowel&#46; Seven days later&#44; this observer rated the same series using the CAPE-V method&#44; this time listening to all the recorded tasks&#46; Observer 2 only performed the CAPE-V scoring&#46; For the rating&#44; the observers played back the voices in a quiet environment&#44; listening with the computer loudspeakers or headphones in blocks of 20&#44; with a 10-min rest period between the consecutive blocks&#46; Although both examiners were experienced in auditory-perceptual voice analysis&#44; they received 2 pattern voice scales that were constructed using a spectrographic visual aid for breathy and rough voices&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">2</span></a> After listening to each voice&#44; the observer rated it without sharing information with the other observer&#59; they could listen to the voices again as many times as necessary&#46; The observers did not know the patients&#8217; diagnoses&#44; nor the fact that normal voices were included among those of the patients&#44; because that could compromise rating reliability&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">3</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Statistical Study</span><p id="par0125" class="elsevierStylePara elsevierViewall">The statistical analysis application SPSS 18 &#40;PASW Statistics 18&#41; was used for the statistical study&#46; Data analysis consisted of determining the following&#58;<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">&#40;a&#41;</span><p id="par0130" class="elsevierStylePara elsevierViewall">Reliability &#40;<span class="elsevierStyleItalic">fiabilidad</span>&#41; or consistence&#58; the degree with which an instrument measures with precision&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">4</span></a> Within this section&#44; intraobserver and interobserver consistence are distinguished&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">&#40;b&#41;</span><p id="par0135" class="elsevierStylePara elsevierViewall">Test&#8211;retest reliability&#44; repeatability or intraobserver consistence&#58; this measures the stability of the scores given by the same evaluator for the same subjects and using the same method at different times&#59; in contrast&#44; interobserver reliability consists of estimating the degree of agreement between 2 or more evaluators&#46;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">&#40;c&#41;</span><p id="par0140" class="elsevierStylePara elsevierViewall">Analysing the validity of the CAPE-V protocol&#58; this is define as the capacity of an instrument to measure that for which it has been designed&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">5</span></a> The validity prototype for the analysis of diagnostic tests is the validity of criteria&#46; This is calculated by comparing the new measuring instrument with another already demonstrated validity&#44; which is to serve as a reference for the phenomenon under study&#46; The external criteria method should be an independent measurement obtained by a different method&#44; in which the results of the questionnaire to be validated do not intervene&#46; In our study we used the GRBAS scale as the reference&#44; because it is an extensively used&#44; already-validated scale&#46; The statistics used to evaluate the previously described voice tasks is the intraclass correlation coefficient &#40;ICC&#41;&#44; which makes it possible to evaluate the level of agreement between 2 measurements&#46;</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">&#40;d&#41;</span><p id="par0145" class="elsevierStylePara elsevierViewall">Sensitivity to change of the validated instrument was also determined&#58; this can be defined as the capacity of an instrument to detect changes in the sample after applying a treatment&#46; Student&#39;s <span class="elsevierStyleItalic">t</span>-test was used as a statistic&#44; assuming that the null hypothesis is the absence of change in the mean response in a sample at 2 different moments&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">5</span></a></p></li></ul></p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Interobserver Reliability</span><p id="par0150" class="elsevierStylePara elsevierViewall">This factor evaluates the level of agreement between the 2 observers and is expressed through the ICC with a double randomised affect&#44; where both the vocal samples and the observer are considered random&#46; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> presents the results for each of the 6 CAPE-V parameters&#44; differentiated through the various tasks evaluated&#46; The results fluctuate between 0&#46;93 for general severity in Task 1 and 0&#46;54 for loudness in Task 2&#46; In general&#44; Task 1 shows higher concordance values than the rest of the tasks&#46; The most consistent parameters evaluated are general severity&#44; roughness and breathiness&#44; respectively &#40;ICC&#62;0&#46;750&#41;&#44; while strain and loudness are the least consistent parameters &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Intraobserver Reliability</span><p id="par0155" class="elsevierStylePara elsevierViewall">This reflects the consistence of the 50 ratings given by the same observer at 2 different times&#46; As can be seen in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#44; very high levels of reliability were reached for all the CAPE-V parameters &#40;ICC&#62;0&#46;850&#41;&#46; The best results were obtained for the parameters of Task 1&#44; reflecting our evaluator&#39;s greater experience of in rating vowels&#46; This does not mean there is any reason why the results obtained in the rest of the tasks do not have robust concordance&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Validity of Criteria Between GRBAS and CAPE-V</span><p id="par0160" class="elsevierStylePara elsevierViewall">The degree of agreement between the 2 protocols is expressed through the ICC and correlates a continuous variable based on a visual analogue scale of 100<span class="elsevierStyleHsp" style=""></span>mm such as the CAPE-V with another ordinal variable having 4 categories &#40;GRBAS&#41;&#46; <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> shows the correlation between homologous parameters in the different scales&#46; Task 1 obtains the best correlation results for all the items&#46; General severity&#44; as an CAPE-V with the one that has the most consistence and the highest level of agreement &#40;average ICC&#58; 0&#46;865&#41;&#46; However&#44; breathiness is the parameter that shows the worst correlation &#40;average ICC&#58; 0&#46;612&#41;&#59; this is fundamentally due to the poor results obtained with Task 2 &#40;ICC&#58; 0&#46;133&#41;&#46; The parameters roughness and strain show good correlation with the 2 scales&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0165" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 1</a> shows the correlation between the ratings on the different scales for general severity&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Sensitivity to Change</span><p id="par0170" class="elsevierStylePara elsevierViewall">The existence of significant differences among the average rating values for each item was analysed&#46; The postoperative results analysed showed significant difference for general severity with both tests used &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41;&#46; In contrast&#44; for the rest of the items studied&#44; the CAPE-V detected significant differences&#44; while the GRBAS did not detect any differences&#46; None of the tests detected differences for the strain parameter &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><elsevierMultimedia ident="tbl0030"></elsevierMultimedia></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Discussion</span><p id="par0175" class="elsevierStylePara elsevierViewall">Perceptual evaluation is an essential method for assessing the pathological voice&#46; This is because it is necessary to apply it in a large number of patients in which the measurements of short-term perturbation are not reliable or they cannot be calculated&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">6</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">Despite the fact that voice perception is the primary tool for judging if there is an alteration in the voice&#44; the methods that rate vocal quality can never be carried out with perfect validity and reliability&#46; Various methods have been described to perform this perceptual evaluation of the voice consistently and in a clinically useful way&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">At present&#44; no method has shown that it is better than the others in the task of measuring perceived vocal quality&#46; Current knowledge is still inadequate for designing a clinical instrument that could resolve all the relevant scientific matters&#46; In fact&#44; the efforts to achieve this have been accompanied by countless problems related to reliability&#44; usefulness and validity&#46; However&#44; there are attempts to develop protocols to document the auditory-perceptual characteristics of alterations in voice quality&#46; Constructing a consistent&#44; specific procedure with a documented format has served to provide these methods with clinical consistence and to improve communication among the clinicians&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">The studies performed to date do not support substituting instrumental means with auditory-perceptual evaluation&#46; To have clinical consideration&#44; however&#44; perceptual evaluation has to follow a standard procedure&#46; At present&#44; the 2 methods most used that provide a standard protocol are the GRBAS and CAPE-V methods&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">7</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">Bearing all this in mind&#44; creating an &#8220;ideal&#8221; method of vocal evaluation has been attempted&#46; This method would propose consistent protocols to differentiate normal voices from pathological ones&#46; It would also correlate with objective measurements and the underlying physiopathology&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">The psychoacoustic sensation of the voice is the main tool in evaluating voice disorders&#44; both for the patients when they explain the change that they notice in their voices&#44; and for the clinicians when describing such changes&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">8&#8211;11</span></a> The auditory-perceptual measurements of vocal quality define the presence or absence of clinical alterations at the laryngeal level&#46; The reason for this is that the continuum between the normal voice and the pathological voice is closely related with vocal health&#46; Specialists in phonology describe vocal alterations through their own perceptual judgements&#44; judgements based on their experience&#44; social and cultural factors and the environment in which they work&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">However&#44; auditory-perceptual voice rating will never be performed with perfect validity or reliability&#44; because these are subjective methods&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">12&#44;13</span></a> This is a controversial subject because the evaluators do not have specific training and there is also a wide variability in inter- and intra-evaluator correlation&#46; Experienced observers have been shown to judge more consistently than non-experts do and to use perceptually different strategies&#59; it has been demonstrated that 8<span class="elsevierStyleHsp" style=""></span>h of training for previously inexperienced observers are enough to obtain interobserver reliability of 80&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">6</span></a> It has also been confirmed that homogeneity of criteria when applying the questionnaire improves consistency among the various observers&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">14</span></a></p><p id="par0210" class="elsevierStylePara elsevierViewall">That is why there is a clear need to create a protocol so that these evaluations are carried out in a more theoretical&#44; clinically significant and consistent manner&#46; The method that comes closest to this focus is the CAPE-V&#44; given that it describes a precise protocol for performing the perceptual evaluation as consistently as possible&#46; However&#44; applying it to the Spanish language is impossible without carrying out an adaptation of the task that analyses connected speech in pre-established sentences &#40;Task 2&#41;&#46; This served as the motivation for this study covering the adaptation and validation of the CAPE-V protocol to Spanish&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">Our work began with adapting the sentences in English from the original document to the Spanish language&#46; This was a task that had not been achieved up until now&#44; making the use of the CAPE-V impossible in our environment&#46; A mere translation of the sentences in Task 2 of the protocol would not be enough and would lack any sense&#59; consequently&#44; we proposed sentences in Spanish that fulfil the phonetic characteristics of those designed in the original language&#44; English&#46; The original sentences have been linguistically adapted&#44; based on the phonetic description included in the original article on the CAPE-V&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">1</span></a></p><p id="par0220" class="elsevierStylePara elsevierViewall">These sentences reveal delicate phonetic situations that help us to detect specific types of vocal alterations related to the capacity for resonance of the voice tract or to the capacity for vocal articulation that cannot be evaluated by the study of sustained vowels&#44; but which make it possible to complete the rating&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Once the sentences had been adapted into Spanish&#44; the next step was to validate the CAPE-V as a useful&#44; reliable tool for perceptual voice evaluation&#59; the instrument had to reflect the relevant vocal characteristics of the human voice&#44; that is&#44; to demonstrate the validity of the construct&#46; The attempt was to achieve a protocol for overall voice evaluation that was complete and universally validated by the specialists&#46; To accomplish this last step the protocol needed to be adapted and implemented in Spanish-speaking countries&#44; which had not been achieved up until now&#46; This study is based on the validation study of the original CAPE-V protocol published by Zraick et al&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">15</span></a> on 74 vocal samples &#40;among which 37 were dysphonic&#44; 22 corresponded to healthy control voices&#44; 11 were repeated samples and 4 were training voices&#41;&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">In contrast to the GRBAS system and other evaluation protocols&#44; the CAPE-V incorporates pitch and loudness into routine vocal evaluation&#46; These parameters are absent from many of the perceptual voice evaluation instruments &#40;for example&#44; the GRBAS&#41; and comparisons of results is consequently limited in the literature&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">16</span></a> The few articles in which they are included show that they are inconsistent parameters that present a lot of inter- and intraobserver variability&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">15</span></a></p><p id="par0235" class="elsevierStylePara elsevierViewall">The use of connected speech in the form of sentences or spontaneous conversation in the CAPE-V method is the most important difference from the GRBAS method&#44; which only uses sustained vowels&#46; This aspect deserves our attention&#44; as we have found differences among ratings with vowels or connected speech&#46; Other authors had already indicated this&#46; An example is the study of Zraick et al&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">15</span></a> in their evaluation of vocal samples by means of sustained vowels&#44; natural conversation and connected voice&#44; establishing that there are significant differences between the first vocal task and the second&#58; the most severe ratings were obtained with sustained vowels&#46; They did not find significant differences between the 2 tasks insofar as connected speech&#58; natural conversation and reading a literary pasaje&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">17</span></a> These findings are also in agreement with the studies by Wolfe et al&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">18</span></a> There are many publications studying the comparison between both phonation tasks&#44; but no consensus has been reached&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">19&#44;20</span></a> Despite all this and with the aim of simplification&#44; it is not unusual to find articles that adapt the well-structured methodology of the CAPE-V to avoid evaluating the 3 vocal tasks and thus simplify the results&#59; this is the case of the Kelchner study<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">21</span></a> in a paediatric population&#44; that uses only Task 2 for vocal rating&#46; In our study&#44; we find results that are very similar to those published by Zraick et al&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">15</span></a></p><p id="par0240" class="elsevierStylePara elsevierViewall">We carried out a comparison between our evaluation using the CAPE-V with the one obtained using the GRBAS system&#44; the current &#8220;gold standard&#8221;&#46; In this comparison&#44; we found significant differences between the ratings in Task 1 and the ratings in Tasks 2 and 3&#46; As is to be expected&#44; the tasks corresponding to connected speech have a similar behaviour and the levels of agreement are above 0&#46;94 for all the parameters evaluated&#46; With respect to Task 1&#44; significant differences are found compared to Tasks 2 and 3&#44; but they do not condition disagreement with the previous evaluations&#44; maintaining a degree of concordance above 0&#46;85&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">Insofar as validity of criteria&#44; the results obtained for Task 1 are similar to those obtained with the GRBAS method&#44; ensuring a very high level of agreement between the 2 tests&#46; However&#44; the results from Tasks 2 and 3 reflect lesser influence in the severity of voice as compared with Task 1 and this reduces the level of agreement in relation to the GRBAS&#46; In this last case&#44; the strength of concordance is lower than that obtained for the previously mentioned vowel phonation&#44; although it remains at intermediate&#47;high levels&#46; We should mention the behaviour of the Task 2 results obtained by the phonetically adapted sentences&#44; which reflect the worst level of agreement with the GRBAS of the 3 tasks assessed&#46; This might be due to the penalisation attributable to the directed phonetic context that strengthens the vowel alterations of the samples&#44; causing sudden glottic attacks&#44; voiceless-voiced transitions&#44; etc&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">Separating the results by parameters&#44; general severity obtains the best results&#46; Roughness&#44; breathiness and strain reflect good correlation between the CAPE-V and GRBAS&#44; but with less strength than general severity&#46; The exception is breathiness in Task 2&#44; which achieves a very low level of agreement&#59; this could be explained because the linguistic context strengthens the escape of air during phonation&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">The intraobserver consistency detected in our study is very high&#44; in all the tasks and for all the parameters&#46; The correlations are higher than 90&#37; in all the cases&#44; findings that are similar to those in previous studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">15&#44;16</span></a></p><p id="par0260" class="elsevierStylePara elsevierViewall">As for interobserver reliability in our study&#44; it has variable ranges from which we can reach several conclusions&#46; The most consistent parameters are general severity&#44; roughness and breathiness&#46; These parameters&#44; regardless of the task&#44; acquire high values and reflect good reliability or consistency&#46; The rest &#40;loudness&#44; pitch and strain&#41; show variable figures in the range of intermediate consistency&#46; In the light of data published in the literature&#44; these are conclusions confirmed by other authors&#58; severity&#44; roughness and breathiness are parameters of demonstrated consistency&#46; Loudness and pitch are items that are hard to rate because of the difficulties in defining and quantifying their alterations&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">22&#8211;25</span></a></p><p id="par0265" class="elsevierStylePara elsevierViewall">Authors such as Karnell<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">14</span></a> have published studies on interobserver consistency with results similar to those of our series&#46; This suggests that the CAPE-V protocol is more sensitive to small rating differences than the GRBAS scale&#46; This characteristic is also emphasised in the Zraick et al&#46; publication&#44;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">15</span></a> defending better CAPE-V results in consistency compared with the GRBAS&#46;</p><p id="par0270" class="elsevierStylePara elsevierViewall">With respect to sensitivity to change&#44; significant differences in the 2 protocols were only found in general severity&#46; This could be due to the high consistency of the parameter&#44; with it being the one that had the greatest overall influence after vocal fold treatment&#46; For the rest&#44; significant differences were only seen with the CAPE-V in roughness&#44; breathiness&#44; loudness and pitch&#46;</p><p id="par0275" class="elsevierStylePara elsevierViewall">Consequently&#44; the CAPE-V protocol in the Spanish language would stand validated&#44; with its concordance with the results obtained with the current reference criteria&#44; which is the GRBAS&#46; It is important to indicate that the CAPE-V method provides a greater wealth of information in perceptual rating&#44; given that it offers an overall voice quality evaluation&#44; widening and completing the rating of sustained vowels&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conclusions</span><p id="par0280" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">1&#46;</span><p id="par0285" class="elsevierStylePara elsevierViewall">The adaptation of the CAPE-V system to Spanish that is proposed can be considered validated by the results of this study&#46;</p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">2&#46;</span><p id="par0290" class="elsevierStylePara elsevierViewall">The perceptual evaluation of the phonetically adapted sentences reflects the worst level of agreement with perceptual evaluation using the GRBAS scale system &#40;sustained vowels&#41;&#46; For this reason&#44; the CAPE-V method provides greater richness in perceptual rating&#44; given that it offers an overall evaluation of voice quality&#44; extending and completing it&#46;</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">3&#46;</span><p id="par0295" class="elsevierStylePara elsevierViewall">Comparing the ratings obtained using the CAPE-V method with the GRBAS scale &#40;gold standard&#41;&#44; general severity is the parameter that obtains the best results&#46; Roughness&#44; breathiness and strain reflect good correlation between the CAPE-V and the GRBAS&#44; but less robustly than with the former&#46;</p></li></ul></p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflict of Interests</span><p id="par0300" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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          "identificador" => "xpalclavsec579103"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Material and Methods"
          "secciones" => array:5 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Description of the CAPE-V Method"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Phonetic Adaptation of the CAPE-V to Spanish"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Participants"
            ]
            3 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Auditory-Perceptual Evaluation of the Voice Samples &#40;GRBAS and CAPE-V&#41;"
            ]
            4 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Statistical Study"
            ]
          ]
        ]
        6 => array:3 [
          "identificador" => "sec0040"
          "titulo" => "Results"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Interobserver Reliability"
            ]
            1 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Intraobserver Reliability"
            ]
            2 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "Validity of Criteria Between GRBAS and CAPE-V"
            ]
            3 => array:2 [
              "identificador" => "sec0060"
              "titulo" => "Sensitivity to Change"
            ]
          ]
        ]
        7 => array:2 [
          "identificador" => "sec0065"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0070"
          "titulo" => "Conclusions"
        ]
        9 => array:2 [
          "identificador" => "sec0075"
          "titulo" => "Conflict of Interests"
        ]
        10 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2014-07-22"
    "fechaAceptado" => "2014-07-30"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec579104"
          "palabras" => array:3 [
            0 => "Voice disorders"
            1 => "Voice analysis"
            2 => "Voice perceptual analysis"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec579103"
          "palabras" => array:3 [
            0 => "Trastornos vocales"
            1 => "An&#225;lisis de la voz"
            2 => "An&#225;lisis perceptual de la voz"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The Consensus Auditory-Perceptual Evaluation of Voice &#40;CAPE-V&#41; was developed to promote a standardised approach to evaluating and documenting auditory perceptual judgments of vocal quality&#46; This tool was originally developed in English language and its Spanish version is still inexistent&#46; The aim of this study was to develop a Spanish adaptation of CAPE-V and to examine the reliability and empirical validity of this Spanish version&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To adapt the CAPE-V protocol to the Spanish language&#44; we proposed 6 phrases phonetically designed according to the CAPE-V requirements&#46; Prospective instrument validation was performed&#46; The validity of the Spanish version of the CAPE-V was examined in 4 ways&#58; intra-rater reliability&#44; inter-rater reliability and CAPE-V versus GRABS judgments&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Inter-rater reliability coefficients for the CAPE-V ranged from 0&#46;93 for overall severity to 0&#46;54 for intensity&#59; intra-rater reliability ranged from 0&#46;98 for overall severity to 0&#46;85 for intensity&#46; The comparison of judgments between GRABS and CAPE-V ranged from 0&#46;86 for overall severity to 0&#46;61 for breathiness&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The present study supports the use of the Spanish version of CAPE-V because of its validity and reliability&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Method"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Con el prop&#243;sito de promocionar un abordaje est&#225;ndar para la evaluaci&#243;n y documentaci&#243;n de las calificaciones perceptuales de la calidad vocal se desarroll&#243; el m&#233;todo CAPE-V &#40;Consensus Auditory-Perceptual Evaluation of Voice&#41;&#46; Originalmente dise&#241;ado en el idioma ingl&#233;s&#44; no existe una adaptaci&#243;n del mismo para ser usado en hispanohablantes&#46; El prop&#243;sito del presente trabajo es proponer una adaptaci&#243;n del protocolo al espa&#241;ol y examinar la fiabilidad y la validez emp&#237;rica de dicha versi&#243;n&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Con el fin de adaptar el protocolo al espa&#241;ol&#44; se proponen seis frases de acuerdo a los requerimientos fon&#233;ticos del CAPE-V&#46; Se llev&#243; a cabo una validaci&#243;n instrumental de forma prospectiva&#46; La validez de la versi&#243;n en espa&#241;ol del CAPE-V se investig&#243; mediante la determinaci&#243;n de la fiabilidad intra- e interobservador y mediante la comparaci&#243;n de las calificaciones obtenidas mediante el CAPE-V con las obtenidas mediante el GRABS&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Los coeficientes de fiabilidad interobservador fluctuaron entre el 0&#44;93 para la severidad global y el 0&#44;54 para la intensidad&#44; mientras que la fiabilidad intraobservador vari&#243; entre el 0&#44;98 para la severidad global y el 0&#44;85 para la intensidad&#46; La comparaci&#243;n entre las calificaciones obtenidas mediante el m&#233;todo GRABS y el CAPE-V obtuvo resultados entre el 0&#44;86 para la severidad global y el 0&#44;61 para la calidad a&#233;rea&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El presente estudio apoya el uso de la versi&#243;n en espa&#241;ol del CAPE-V dada su validez y fiabilidad&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todo"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; N&#250;&#241;ez-Batalla F&#44; Morato-Gal&#225;n M&#44; Garc&#237;a-L&#243;pez I&#44; &#193;vila-Men&#233;ndez A&#46; Adaptaci&#243;n fon&#233;tica y validaci&#243;n del m&#233;todo de valoraci&#243;n perceptual de la voz CAPE-V al espa&#241;ol&#46; Acta Otorrinolaringol Esp&#46; 2015&#59;66&#58;249&#8211;257&#46;</p>"
      ]
    ]
    "apendice" => array:1 [
      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0305" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="fig0005"></elsevierMultimedia></p>"
            "etiqueta" => "Annex 1"
            "titulo" => "Consensus Auditory-Perceptual Evaluation of Voice &#40;CAPE-V&#41;"
            "identificador" => "sec0080"
          ]
        ]
      ]
    ]
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      0 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1311
            "Ancho" => 1626
            "Tamanyo" => 50969
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Concordance of general severity between the CAPE-V and GRBAS&#46;</p>"
        ]
      ]
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        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
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        "tabla" => array:1 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pathology&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patients operated on&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Vocal polyp&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">New laryngeal vessels&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Reinke&#39;s oedema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Subepithelial cysts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Nodules&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Serous pseudocyst&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Leukoplakia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Idiopathic vocal paralysis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Posterior third granuloma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Laryngeal papillomatosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Diagnoses of the Entire Patient Group and of the Subgroup Operated Surgically&#46;</p>"
        ]
      ]
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        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Parameter&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Task 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Task 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Task 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">General severity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;935&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;879&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;833&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Roughness&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;907&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;775&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;750&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Breathiness&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;894&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;773&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;769&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Strain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;648&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;698&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;738&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Pitch&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;795&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;710&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;806&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Loudness&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;763&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;545&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;617&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab911640.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Interobserver CAPE-V Consistency&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Parameter&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Task 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Task 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Task 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">General severity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;988&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;972&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;978&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Roughness&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;981&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;969&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;972&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Breathiness&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;979&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;968&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;952&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Strain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;971&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;921&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;935&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Pitch&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;963&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;918&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;894&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Loudness&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;961&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;895&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;851&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab911642.png"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Intraobserver CAPE-V Consistency&#46;</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "tbl0020"
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        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "tabla" => array:1 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CAPE versus GRBAS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Task 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Task 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Task 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Average ICC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">General severity</span> &#8211; <span class="elsevierStyleItalic">grade</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;965&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;789&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;866&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;874&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Roughness</span> &#8211; roughness&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;950&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;755&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;842&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;849&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Breathiness</span> &#8211; breathiness&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;961&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;133&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;742&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;612&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Strain</span> &#8211; strain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;912&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;819&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;799&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;843&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab911638.png"
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Level of Agreement Between GRBAS and CAPE-V Results&#46;</p>"
        ]
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      5 => array:7 [
        "identificador" => "tbl0025"
        "etiqueta" => "Table 5"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
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              "tabla" => array:1 [
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">General severity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Means&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Grade&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Means&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Difference of means</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Significance&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Pre&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68&#46;86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pre&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">General severity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;727&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Post&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Grade&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;682&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Sensitivity to General Severity Change&#46;</p>"
        ]
      ]
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        "etiqueta" => "Table 6"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col">Tasks 1&#44; 2 and 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Level of significance of the differences</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CAPE-V&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">GRBAS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">General severity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Roughness&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Breathiness&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;038&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Strain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;044&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;090&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Sensitivity to CAPE-V and GRBAS Change&#46;</p>"
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      ]
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    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
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          "bibliografiaReferencia" => array:25 [
            0 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "1"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Consensus auditory perceptual evaluation of voice&#58; development of a standardized clinical protocol"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "G&#46;B&#46; Kempster"
                            1 => "B&#46;R&#46; Gerratt"
                            2 => "K&#46; Verdolini Abbott"
                            3 => "J&#46; Barkmeier-Kramer"
                            4 => "R&#46;E&#46; Hillman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1044/1058-0360(2008/08-0017)"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Speech Lang Pathol"
                        "fecha" => "2009"
                        "volumen" => "18"
                        "paginaInicial" => "124"
                        "paginaFinal" => "132"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18930908"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
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            1 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "2"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "El espectrograma de banda estrecha como ayuda para el aprendizaje del m&#233;todo GRABS de an&#225;lisis perceptual de la disfon&#237;a"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46; N&#250;&#241;ez-Batalla"
                            1 => "J&#46;P&#46; D&#237;az-Molina"
                            2 => "I&#46; Garc&#237;a-L&#243;pez"
                            3 => "A&#46; Moreno-M&#233;ndez"
                            4 => "M&#46; Costales-Marcos"
                            5 => "C&#46; Moreno-Galindo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.otorri.2011.10.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Otorrinolaringol Esp"
                        "fecha" => "2012"
                        "volumen" => "63"
                        "paginaInicial" => "173"
                        "paginaFinal" => "179"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22153964"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Does knowledge of medical diagnosis bias auditory-perceptual judgments of dysphonia&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "T&#46; Eadie"
                            1 => "A&#46; Sroka"
                            2 => "D&#46;R&#46; Wright"
                            3 => "A&#46; Merati"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jvoice.2009.12.009"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Voice"
                        "fecha" => "2011"
                        "volumen" => "25"
                        "paginaInicial" => "420"
                        "paginaFinal" => "429"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20347262"
                            "web" => "Medline"
                          ]
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                      ]
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                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Validaci&#243;n de cuestionarios"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46;J&#46; Garc&#237;a de Y&#233;benes"
                            1 => "F&#46; Rodr&#237;guez Salvan&#233;s"
                            2 => "L&#46; Carmona Ortells"
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Article information

ISSN: 21735735
Original language: English

DOI:10.1016/j.otoeng.2015.08.001

The statistics are updated each day

Year/Month	Html	Pdf	Total

2021 August	1	2	3
2021 February	0	1	1
2020 November	5	6	11
2020 October	0	1	1
2020 July	0	1	1
2020 March	34	3	37
2020 February	346	8	354
2020 January	52	11	63
2019 December	108	12	120
2019 November	30	8	38
2019 October	40	6	46
2019 September	64	10	74
2019 August	24	5	29
2019 July	45	14	59
2019 June	119	12	131
2019 May	180	28	208
2019 April	81	22	103
2019 March	44	12	56
2019 February	33	11	44
2019 January	21	8	29
2018 December	27	18	45
2018 November	36	8	44
2018 October	32	4	36
2018 May	5	0	5
2018 April	39	10	49
2018 March	30	6	36
2018 February	13	4	17
2018 January	24	9	33
2017 December	32	0	32
2017 November	45	11	56
2017 October	62	3	65
2017 September	33	18	51
2017 August	31	9	40
2017 July	47	3	50
2017 June	54	12	66
2017 May	51	11	62
2017 April	31	6	37
2017 March	30	30	60
2017 February	24	6	30
2017 January	15	4	19
2016 December	24	16	40
2016 November	57	9	66
2016 October	40	8	48
2016 September	47	7	54
2016 August	32	9	41
2016 July	35	6	41
2016 June	44	17	61
2016 May	43	28	71
2016 April	51	17	68
2016 March	44	25	69
2016 February	57	27	84
2016 January	42	20	62
2015 December	54	26	80
2015 November	70	28	98
2015 October	67	30	97

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