Noise-to-Harmonics Ratio as an Acoustic Measure of Voice Disorders in Boys

This prospective study assessed the efficacy of computerized noise-to-harmonics ratio (NHR) to quantify perceptual and endoscopic findings of dysphonia and/or structural lesion of the vocal fold. Fifty Brazilian boys without vocal complaints were submitted to computerized, perceptual, and endoscopic examination. Thirty boys were dysphonic—3 were classified into the grade category, 5 into breathiness, 9 into roughness, and 15 into grade/breathiness. Vocal fold lesions were observed in 25 boys (17 nodules and 8 cysts). The Mann-Whitney U test revealed that NHR was significantly higher in boys with a structural lesion (p = 0.007) and in boys with dysphonia (p < 0.0001). However, according to a logistic regression model, only the occurrence of dysphonia was explained by NHR; the risk for having dysphonia increased approximately twice (odds ratio = 1.92, 95% confidence interval = 1.3 − 2.9) with each increase of 0.01 in NHR. Our results suggest that noise is a useful quantitative index to confirm a perceptual diagnosis of dysphonia and to evaluate quantitative changes in a dysphonic voice over time. However, we believe that computerized analysis should be used as a complement, rather than a substitute, for perceptual evaluation. Further studies with a larger sample are required to investigate the relationship between noise and lesions of the vocal folds.