PERCEPTUAL EVALUATION SCALE OF THE GLOTTIC SOURCE: RASAT

2002

Dr.SílviaRebeloPinho [Link]
Director of INVOZ - Institute of Voice. Head of Director of INLAR - Institute of the Larynx
Department of Voice of CEFAC - Center of Full Professor of ENT at UNIFESP
Specialization in Clinical Speech Therapy - Brazil Federal University of São Paulo - Brazil

Authors' observation: In 2008, the "I" was introduced into the RASAT scale.
Regarding vocal instability. The publication below still does not include this new one.
[Link] last publication of the RASAT Scale that includes the "I" of 'Instability' was
published in the book: PINHO SMR, PONTES P - Intrinsic Laryngeal Muscles and Dynamics
Vocal.(SeriesUnveilingtheSecretsoftheVoice).[Link],RiodeJaneiro,2008.

Variousvocalevaluationproposals Phonatory of the Japanese Society of

perceptions have been presented in the LogopediaandPhoniatrics(SJLF)in1969,withthe
world literature. The main focus of end of evaluating the voice at the glottic level; and the

These proposals consist of analyzing the voice in Phonetic Model for Describing Quality
two sectors: Vocal-SourceandFilter”(Laver,1980)was
performed for the global evaluation of the voice.
1) Source (sounding): it is when the
perceptual voice assessment is carried out The scale GRBAS for the
considering the alterations of the vibration vocalperceptualevaluation a level
mucosa of the vocal cords. In this gothic was considered by Hirano (1981)
if the analysis is restricted to sound hoarsenescsaw
le,heG
re-Grade,
produced in the glottal source, relating to it means in the dictionary of the language
the fundamental frequency to the harmonics. {"pourtguesa":Pourtguese"G
, rado":Gra"ftR
, -Rough":RR
-ough"Á
, spero":Rough"B
, -":B-"}

Example: glottic carcinoma, vocal nodules, BreathSopl

, oso;A-AsthenicAst
, enico;S
vocal cord edema, etc. -Straight, Tenso.

2) Filter (output signal): it is when the For the vocal triage carried out in the
perceptual vocal assessment is conducted Brazilian population during the Campaign
considering the passage of the harmonics National Voice of 2001, organized by the
produced by the glottal source through the Brazilian Society of Laryngology and Voice
vocal tract (sound filtering effect). (SBLV), we opted for the use of the scale
this situation the analysis is broader and GRBAS. The reason for such selection
includes the vocal aspects related to justified, since the approach of the Campaign
the articulation and the resonance. it was glottic carcinoma and GRBAS scale
presents itself as an effective instrument in the

Thevocalevaluationscales perceptual identification of disturbances

the most widespread perceptual scales are: 'GRBAS' related vowels a the irregularity
created by the Committee for Function Tests vibratory of the vocal cords - source
 2

glottic. In addition to the aforementioned, isolated organic alteration in the mucosa

quick application procedure vibratory, or; groove of any
considering the large number of people in associated dimension theapresence of
tobeevaluated. organic alteration of the vibratory mucosa.
Acharacteristic example of hoarseness occurs
onitoarefugslenasutlP
T
hrofetiaf vocal nodules, hyperemia and edema.
of the term Rough - rough, carried out by Esta situación genera ruidos adventiciosen
Pinho, Pontes (2001), and used in the low frequency (Hirano et al, 1990;
content of the explanatory video of the scale Hammarberg, Gauffin, 1995; Hammarberg,
GRBAS driecetd ot hte coordniaotrs of hte 2000), masking in the traced
Campaign, led me to make an adaptation in spectrogram of the lower harmonics.
the scale that, originaly, did not contemplate voice presents irregular, producing a
clearly, the aspect of roughness, noise similar to the sound of a flag
characteristic of the rigidity frames of the shivering in front of a strong wind.
mucosa; which is extremely important in the

perceptual evaluation of the voice, when The perceptual aspect, more specific,
we are facing glottic carcinoma. The regarding roughness, it is related to the
roughen the English tongue rigidity of the mucosa, which also causes some
it is generally used to characterize vibrational irregularity depending on the
irregularity of the vibration, being, by presence of glottal slit and of the
So, imprecise in the distinction between the association with other laryngeal disorders
perceptual aspects of hoarseness and the such as edema. Meanwhile, in the
roughness. Analyzing the strip of clinical cases cases where the stiffness factor predominates,
illustrative of the GRBAS scale in the video vocal quality is a well-defined characteristic, whose
original, prepared by the SJLF, we observe impression is laid a dry and without voice
those vocal samples intensely projection. In acoustic analysis, these voices
irregulars they were considered Rough are characterized by the presence of noises
regardless of whether the rough component in high frequency (Hirano et al, 1990;
the snore prevailed. In our opinion, the Hammarberg, Gauffin, 1995; Hammarberg,
terms Separate hoarseness and harsh 2000). This is possibly due to the great
forroughnesstheywouldbemoreprecise. waste of air during vocal emission,
what is necessary to trigger vibration
For Isshiki (1980) the larva, rigid mucosa, favoring the
justifies for the vibrational irregularity of the visualization of the lower harmonics. A
mucosa of the vocal cords during classic example of hoarse voice due to rigidity of
voicing due to the: isolated presence of mucosa is found in cases of sulcus
2
glottic gap greater than or equal to 0.5 mm vocal. The cysts, bridges y bags
(approximate value, based on research) they generally have a hoarse voice associated with
experimental developed by the author in a more intense hoarseness, due to the edema,
human larynges excised); presence that frequently accompanies them.
3

Supportedbythisdataand,also ndeoihatnT
w
roinetcsvatolics
considering the definition of hoarseness for increased glottal translation
obtained through experiments of (hyperfunction), generally related to
Isshiki (1980), we adapt the GRBAS scale increase in muscle activity
we actually started to use it as a extrinsic to the larynx, causing its
scaleo f e v a l u a t i o n of hoarseness, elevation. Example: spasmodic dysphonia of
as suggested by Hirano (1981) in his book, already translation, tension vocal syndromes, etc.
that all aspects of the ladder can
toberelatedtovibrationalirregularity. We also use graduation.
Consequently, we proceed to consider the originally proposed for the GRBAS scale
Grado,whichwasoriginallyaddressedbythe in each of its topics according to the
SJLF, as a general degree of voice deviation; vocal commitment, in 4 levels: normal
how to deal with hoarseness; and the others (0),leve (1), moderado (2) eintenso (3).
aspects, we use, in the terms We consider: Norm a l (0) when none
corresponding, to the exact translation of the vocal alteration is perceived by the listener;
English for the Portuguese language. In our Level(1)forslightvocalalterationsor
opinion, use Gra as a general degree of in case of doubt, that is, if the alteration is
Deviating from the voice would not be convenient, sincepresent or not; Moderate (2) when
vocal alterations can also the alteration is evident, and; Intense (3) for
occur due to imbalances in other sectors of extreme vocal alterations. Also
vocal tract. In this way we want we consider the possibility of graduation of
reach a consensus regarding the trial 1 for 2 and 2 for 3, as viable for
auditory and its physiological correlations. The determine intermediate disturbances.
other aspects did not present controversies,
being Theemissionsusedforjudging
perceptively the voice is: vowel /a/
daL
iospaldpn,osegdriocrot
the prolonged (more open vowel), vowel /e/ (for
presence of background noise, audible and whose to be used in the exam laryngological)
the most frequent physiological correlation is the sample of stuck speech.
presence of glottic cleft. Remember that,
exceptionally, we can to find The specialist in the voice area must
softness in cases of extreme rigidity to have the ability to integrate the dimensions
mucosa in absence of glottic cleft. perceptivas, acoustics physiological y
psychological aspects of the voice during its evaluation.
The asthenia, correlated with Thus,theirperceptualjudgmentmustbeconsidered
hypofunction of the vocal cords and little as your diagnostic hypothesis. Alterations
energy in the emission, as observed in vowels related to the GRBAS scale in the
neurological cases, for example, myasthenia moment of the emission they imply
serious. necessafrinly,dingensdoscopic
 4

that justify. In these cases, if the To facilitate the triage procedure

conventional logical examination no perceptual vocal of the glottic level, in our
no organic alteration is identified, it becomes country, and moving away from issues with-
it is essential to carry out an evaluation controversial, related to the GRBAS scale, it is
more detailed a through the language of our that, we suggest the adoption of a new
boscopia abbreviation: "RASAT", where R corresponds to the
hoarsenA
alhtezsenisb,;S
eres,sa;htA
nides,;s

Piccirillo et al (1998) judged asthenia and tension. Graduation from 0 to 3

important to attach the GRBAS scale topic and their intermediaries will be maintained in each

instability characterizing it evaluated topic.

scale thus, GRBASI. Sin embargo
we disagree with this proposal, considering In this way, we judge that this-
that vocal instability frequently giving us another perspective on the utilization of

corresponds to the tremor of structures of the this instrument in new campaigns and in
vocal tract, drifting away from the objective clinical assessment of the specialist in the area of
primordial to evaluate exclusively the voice.
vocal alterations coming from the source
glottal.

REFERENCEAS I BUY BIBLIOGRAPHY CAS

Committee for Phonatory Function Tests of the Japanese Society of Logopedics and Phoniatrics - Video Tape
illustrative of the "GRBAS", 1969.

HammarbergB, Gauffin J – Perceptual and acoustics characteristics of quality differences in pathological voices
as related to physiological aspects. In: Fujimura O, Hirano, M – Vocal fold physiology. San Diego, Singular
Publishing Group Inc., 1995. p. 283-303. 1995.

Hammarberg B – Voice research and clinical needs. Folia Phoniat. Loop., 52: 93-102, 2000

HiranoM.-Clinical examination of voice. -Vienna, Springer-Verlag, 1981, 100p.

HiranoM, Yoshida T; Tanaka S, Hibi S - Vocal sulcus: functional aspects. Ann. Otol. Rhinol. Laryngol.; 99:679-
83, 1990.

Isshiki N - Recent advances in phonosurgery. Folia Phoniatr. (Basel), 32:119-54, 1980.

LaverJ.-[Link],Cambridge,1980.

Pinho SMR, Pontes PAL - Vídeo explicativo da escala GRBASdirigidoaos coordenadores daCampanhaNacional
daVoz - São Paulo - 2001.

Piccirillo JF, PainterC, FullerD, HaidukA, Fredrickson JM –Assessment of two objective voice function indices.
[Link].;107(5Pt1):396-400,1998.