Pediatric Auditory-Perceptual Evaluation of Voice Part I: Voice Stimuli for Children.

PURPOSE: The purpose of this study was to develop and test standardized stimuli for the Pediatric Auditory-Perceptual Evaluation of Voice protocol. The use of these stimuli for cepstral/spectral voice measures was also considered. METHOD: Three sets of standardized sentences and four prompts designed to elicit connected speech were developed and tested in order to identify the most effective stimuli for use with children. One hundred forty children with (n = 50) and without (n = 90) benign vocal fold lesions recorded all potential stimuli, as well as the sentences developed for the adult Consensus Auditory-Perceptual Evaluation of Voice protocol. Sentences were evaluated for production accuracy, and cepstral/spectral voice measures were calculated to determine whether potential stimuli would separate dysphonic and normophonic voices. Spontaneous speech prompts were assessed for duration of speech sample elicited. Subsequently, auditory-perceptual voice assessments were performed using the newly developed pediatric stimuli. Production accuracy, cepstral/spectral voice measures, and auditory-perceptual rating reliability were compared across age, sex, and voice diagnosis. RESULTS: Children produced pediatric sentences significantly more accurately than sentences developed for adults. The best produced sentence set resulted in over 80% accuracy across children 3 through 17 years of age. Cepstral peak prominence calculated on these sentences was significantly lower for children with voice disorders when compared to those with typical voices. Spontaneous speech prompts elicited an average of about 40 syllables of phonation over 25-30 s in children ≤ 6 years of age, and voice samples increased in duration for older children. Auditory-perceptual ratings of voice significantly separated children with and without voice disorders and produced reliability levels similar to those previously reported for adults. CONCLUSION: Findings indicate that the developed pediatric stimuli are effective for auditory-perceptual assessments across childhood and can be produced more accurately than sentences designed for adults.