“…Each parameter is scored on a visual analogue scale from 0 (minimally deviant) to 10 (maximally deviant substitution voicing). This validated auditory-perceptual scale, the reliability of which has also been proven in native Italian-speaking patients [ 12 , 13 , 14 , 15 , 16 ], seems to overwhelm the limits of the previously proposed GRBAS perceptual rating scale (grade, roughness, breathiness, asthenia, strain, on a scale of 0–3, where 0 = normal, 1 = mild degree, 2 = moderate degree and 3 = high degree) [ 17 ]. Even if the GRBAS scale presented a positive correlation with acoustic, aerodynamic and voice-related quality of life questionnaires [ 18 , 19 , 20 ], it does not seem to be the best tool for evaluating substitution voices.…”