Test-retest reliability for aerodynamic measures of voice

The purpose of this study was to investigate the intrasubject reliability of aerodynamic characteristics of the voice within typical/normal speakers across testing sessions using the Phonatory Aerodynamic System (PAS 6600; KayPENTAX, Montvale, NJ).

Participants were 60 healthy young adults (30 males and 30 females) between the ages 18 and 31 years with perceptually typical voice. Participants were tested using the PAS 6600 (Phonatory Aerodynamic System) on two separate days with approximately 1 week between each session at approximately the same time of day. Four PAS protocols were conducted (vital capacity, maximum sustained phonation, comfortable sustained phonation, and voicing efficiency) and measures of expiratory volume, maximum phonation time, mean expiratory airflow (during vowel production) and target airflow (obtained via syllable repetition), peak air pressure, aerodynamic power, aerodynamic resistance, and aerodynamic efficiency were obtained during each testing session. Associated acoustic measures of vocal intensity and frequency were also collected. All phonations were elicited at comfortable pitch and loudness.

All aerodynamic and associated variables evaluated in this study showed useable test-retest reliability (ie, intraclass correlation coefficients [ICCs] ≥ 0.60). A high degree of mean test-retest reliability was found across all subjects for aerodynamic and associated acoustic measurements of vital capacity, maximum sustained phonation, glottal resistance, and vocal intensity (all with ICCs > 0.75). Although strong ICCs were observed for measures of glottal power and mean expiratory airflow in males, weaker overall results for these measures (ICC range: 0.60-0.67) were observed in females subjects and sizable coefficients of variation were observed for measures of power, resistance, and efficiency in both men and women. Differences in degree of reliability from measure to measure were revealed in greater detail using methods such as ICCs and coefficients of variation than with means comparison testing. The results of this study also show that reliable aerodynamic and associated measures may be elicited using comfortable pitch and loudness.

The 1-week test-retest reliability for the majority of aerodynamic and associated acoustic measures assessed in this study is considered good-to-excellent. Clinicians and researchers using aerodynamic and associated measures should be aware of possible significant gender effects that influence both normative expectations as well as the standard error of measurement (ie, typical error) and estimates of minimum difference that may be used to differentiate typical from disordered voice.