Maximum phonation time: variability and reliability

The objective of the study was to determine maximum phonation time reliability as a function of the number of trials, days, and raters in dysphonic and control subjects. Two groups of adult subjects participated in this reliability study: a group of outpatients with functional or organic dysphonia versus a group of healthy control subjects matched by age and gender. Over a period of maximally 6 weeks, three video recordings were made of five subjects' maximum phonation time trials. A panel of five experts were responsible for all measurements, including a repeated measurement of the subjects' first recordings. Patients showed significantly shorter maximum phonation times compared with healthy controls (on average, 6.6 seconds shorter). The averaged interclass correlation coefficient (ICC) over all raters per trial for the first day was 0.998. The averaged reliability coefficient per rater and per trial for repeated measurements of the first day's data was 0.997, indicating high intrarater reliability. The mean reliability coefficient per day for one trial was 0.939. When using five trials, the reliability increased to 0.987. The reliability over five trials for a single day was 0.836; for 2 days, 0.911; and for 3 days, 0.935. To conclude, the maximum phonation time has proven to be a highly reliable measure in voice assessment. A single rater is sufficient to provide highly reliable measurements.