Perceptual, patient-reported, and acoustic voice characteristics in individuals with multiple sclerosis

Purpose:Voice impairment is increasingly recognised as a relevant but often underexplored feature of multiple sclerosis (MS). The present study aimed to investigate vocal characteristics in individuals with MS using a combined subjective, perceptual, and acoustic assessment approach. Methods: A total of 91 participants were included, comprising 48 individuals with MS and 43 healthy controls. Vocal function was assessed using the Voice Handicap Index (VHI), the GRBAS perceptual scale, and acoustic analysis of sustained phonation, including fundamental frequency (fo), jitter, shimmer, and harmonics-to-noise ratio (HNR). Analyses were conducted separately for men and women. Results: Participants with MS showed significantly higher VHI and GRBAS scores compared to controls in both sexes, indicating greater perceived and perceptual voice impairment. Analysis of individual GRBAS dimensions revealed significantly higher scores across all components (Grade, Roughness, Breathiness, Asthenia, and Strain) in participants with MS compared with controls. Acoustic analysis revealed significantly increased shimmer values in both men and women with MS, whereas significantly lower HNR and fo values were observed only among women in the sex-stratified analyses. No significant differences were identified for jitter. Formal interaction analyses revealed a significant group × sex interaction only for fo, whereas no significant interaction was observed for HNR, shimmer, or jitter. Conclusions: Combined perceptual, patient-reported, and acoustic voice assessment may contribute to a broader characterisation of voice impairment in individuals with MS.