The Relationship Between Auditory-Perceptual Rating Scales and Objective Voice Measures in Children With Voice Disorders

Purpose: The purpose of this study was to determine concurrent validity of the Grade, Roughness, Breathiness, Asthenia, and Strain (GRBAS) and Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) auditory-perceptual scales in children with voice disorders. A secondary purpose was to determine correlation between the GRBAS, CAPE-V, and objective voice measures. Method: GRBAS and CAPE-V ratings and acoustic and aerodynamic measures were collected from the University of Wisconsin-Madison Voice and Swallow Outcomes Database. Correlations between CAPE-V and GRBAS ratings were calculated for overall severity of dysphonia, roughness, breathiness, and strain. Correlations between auditory-perceptual voice ratings and objective voice measures were also examined. Results: One hundred thirty GRBAS and CAPE-V auditory-perceptual ratings were significantly correlated for overall severity, roughness, breathiness, and strain. r(2) values were highest for overall severity of dysphonia (r(2) = .75) and lowest for strain (r(2) = .54). CAPE-V and GRBAS ratings were largely associated with similar acoustic and aerodynamic measures. The highest correlations were observed for auditory-perceptual ratings of breathiness and jitter% (CAPE-V r(2) = .44, GRBAS r(2) = .44), shimmer% (CAPE-V r(2) = .45, GRBAS r(2) = .45), noiseto-harmonic ratio (CAPE-V r(2) = .42, GRBAS r(2) = .40 fundamental frequency (CAPE-V = .47, GRBAS .44), and maximum phonation time (CAPE-V r(2) = .56, GRBAS r(2) = .51). Akaike information criterion values indicated that CAPE-V ratings were more strongly correlated with objective voice measures than GRBAS ratings. Conclusions: CAPE-V and GRBAS scales have concurrent validity in children with voice disorders. CAPE-V ratings are more strongly correlated with acoustic and aerodynamic voice measures.