Abnormal Voice Quality Research Articles

Auditory-Perceptual and Pupillometric Evaluation of Vocal Roughness and Listening Effort in Tracheoesophageal Speech

This study evaluated auditory-perceptual judgments of perceived vocal roughness (VR) and listening effort (LE) along with pupillometric responses in response to speech samples produced by tracheoesophageal (TE) talkers. Twenty normal-hearing, naive young adults (eight menand twelve women) served as listeners. Listeners were divided into two groups: (1) a with-anchor (WA) group (four menand six women) and (2) a no-anchor (NA) group (four menand six women). All were presented with speech samples produced by twenty TE talkers; listeners evaluated two auditory-perceptual dimensions-VR and LE-using visual analog scales. Anchors were provided to the WA group as an external referent for their ratings. In addition, during the auditory-perceptual task, each listener's pupil reactions also were recorded with peak pupil dilation (PPD) measures extracted as a physiologic indicator associated with the listening task. High interrater reliability was obtained for both the WA and NA groups. High correlations also were observed between auditory-perceptual ratings of roughness and LE, and between PPD values and ratings of both dimensions for the WA group. The inclusion of an anchor during the auditory-perceptual task improved interrater reliability ratings, but it also imposed an increased demand on listeners. Data obtained offer insights into the relationship between subjective indices of voice quality (ie, auditory-perceptual evaluation) and physiologic responses (PPD) to the abnormal voice quality that characterizes TE talkers. Furthermore, these data provide information on the inclusion/exclusion of audio anchors and potential increases in listener demand in response to abnormal voice quality.

Endoscopic evaluation of velopharyngeal function in cleft lip palate patients – A correlation with speech analysis

Speech abnormalities due to velopharyngeal insufficiency (VPI) significantly affect communication skills, self-esteem, and scholastic performance. It leads to a poor social, emotional, educational, and behavioral development and a poor quality of life overall in cleft lip palate (CLP) patients. Its early diagnosis and severity assessment using video-nasoendoscopy and speech assessment can significantly contribute to management. The present study evaluated VPI in CLP patients using both tools. A total of 48 patients with repaired cleft palate were subjected to speech and video-nasoendoscopic assessment. Speech assessment measured severity of hypernasality, speech intelligibility, and voice quality. Video-nasoendoscopy evaluated velopharyngeal port closure to grade the severity of VPI. The speech assessment and video-nasoendoscopy findings were analyzed and correlated. There was a moderately strong statistically significant negative correlation between the grade of VPI and hypernasality (r=-0.542, p=0.000). There was a stronger statistically significant negative correlation of grade of velopharyngeal port insufficiency with speech intelligibility (r=-0.634, p=0.000). About 72% of the patients had abnormal voice quality. This study is the first attempt at diagnosing and grading VPI on a quantitative scoring based on a ratio scale for the motion of soft palate and pharyngeal walls. The strong correlation between endoscopic grading and speech analysis findings warrants further evaluation of nasoendoscopic grading of VPI in more studies.

A 10-year-old girl with acute shortness of breath

A 10-year-old girl with known allergies and asthma presented with a 2-year gradual worsening of asthma symptoms and recent dramatic escalation, including multiple exacerbations requiring emergency department treatment but no intubation or ICU admission. Her asthma was well controlled on minimal treatment until age 8. Presenting symptoms included shortness of breath, chest tightness, audible wheeze, abnormal voice quality, and frequent rapid-onset attacks with hoarse voice and inspiratory difficulty unresponsive to short-acting bronchodilators. She also had significant shortness of breath on exertion resulting in restricted activity. Respiratory symptoms at school, particularly in one area, caused severe anxiety resulting in home-schooling, social isolation, and agoraphobia. Over 2 years, her asthma therapy had been escalated from low-dose inhaled corticosteroid (ICS) to combined anti-IgE antibody, very high-dose ICS, long-acting bronchodilator, leukotriene receptor antagonist, and short-term oral steroids more than monthly for breakthrough symptoms. Additional medications included nasal steroid, oral antihistamine, proton pump inhibitor, and an oral contraceptive. Side effects of frequent oral steroids included weight gain (body mass index > 95th percentile) and comorbidities included gastroesophageal reflux. Spirometry and physical examination were normal. An additional investigation revealed the diagnosis.

The acoustic voice quality index version 02.02 in the Finnish-speaking population

Background: The Acoustic Voice Quality Index (AVQI) is a multiparametric tool for objectively measuring the general acoustic characteristics of voice. The AVQI uses both sustained vowel and continuous speech in its analysis, and therefore, a validation is required for different languages. In the present study, validation was performed in the Finnish-speaking population.Methods: The study included 200 native Finnish-speaking participants of whom 115 were voice patients attending a phoniatric clinic, and the remaining 85 subjects participated in the study as healthy controls. Voice samples were recorded, and the auditory evaluation was performed by five speech therapists. An ordinal four-point interval scale was used to evaluate the degree of voice abnormality (Grade, G). Several statistical analyses were performed to test the validity and the diagnostic accuracy of the AVQI in the Finnish-speaking population.Results: The inter-rater reliability of four of the five raters was high enough to allow the use of Gmean in the validation. There was a statistically significant correlation between the AVQI scores and the evaluation of overall perceptual voice quality (r = 0.74).Conclusions: The results confirmed the good discriminatory power of the AVQI in differentiating between normal and abnormal voice qualities. The AVQI 02.02 threshold value for dysphonia was 2.87 in the Finnish-speaking population.

Validation of the Acoustic Voice Quality Index Version 03.01 and Acoustic Breathiness Index in German

The aim of this study was to validate the acoustic voice quality index (AVQI) version 03.01 and the acoustic breathiness index (ABI) in the German language. Concatenated voice samples of continuous speech (cs) and sustained vowel (sv) [a:] from 175 subjects with dysphonia and 43 vocally healthy subjects were perceptually judged for overall voice quality and breathiness severity. First, to reach a higher level of ecological validity, the proportions of cs and sv were equalized regarding the time length. Second, concurrent validity and diagnostic accuracy were statistically verified using the Spearman rank-order correlation coefficient (rs) and several estimates of the receiver operating characteristics, likelihood ratio, and Youden index. A moderate reliability of overall voice quality and breathiness severity from three experts were found. It was found that 27 syllables as standardization of the cs part, which represents 3 seconds of voiced cs, allows the equalization of both speech tasks. A strong correlation was revealed between AVQI and overall voice quality (rs = 0.86, P < 0.01), and ABI and perceived breathiness severity (rs = 0.85, P < 0.01). Additionally, the best diagnostic outcome for AVQI and ABI was identified at a threshold of 1.85 (sensitivity of 72 % and specificity of 90 %) and 3.42 (sensitivity of 72 % and specificity of 95 %), respectively. AVQI and ABI showed in the German language valid and robust results to quantify abnormal voice qualities regarding overall voice quality and breathiness severity.

Validation of the Acoustic Voice Quality Index Version 03.01 and the Acoustic Breathiness Index in the Spanish language.

The aim of this study was to validate the Acoustic Voice Quality Index 03.01 (AVQIv3) and the Acoustic Breathiness Index (ABI) in the Spanish language. Concatenated voice samples of continuous speech (cs) and sustained vowel (sv) from 136 subjects with dysphonia and 47 vocally healthy subjects were perceptually judged for overall voice quality and breathiness severity. First, to reach a higher level of ecological validity, the proportions of cs and sv were equalized regarding the time length of 3 seconds sv part and voiced cs part, respectively. Second, concurrent validity and diagnostic accuracy were verified. A moderate reliability of overall voice quality and breathiness severity from 5 experts was used. It was found that 33 syllables as standardization of the cs part, which represents 3 seconds of voiced cs, allows the equalization of both speech tasks. A strong correlation was revealed between AVQIv3 and overall voice quality and ABI and perceived breathiness severity. Additionally, the best diagnostic outcome was identified at a threshold of 2.28 and 3.40 for AVQIv3 and ABI, respectively. The AVQIv3 and ABI showed in the Spanish language valid and robust results to quantify abnormal voice qualities regarding overall voice quality and breathiness severity.

The Exploration of an Objective Model for Roughness With Several Acoustic Markers

In voice assessment, the evaluation of voice quality is a major component in which roughness has received wide acceptance as a major subtype of abnormal voice quality. The aim of the present study was to develop a new multivariate acoustic model for the evaluation of roughness. In total, 970 participants with dysphonia and 88 participants with normal voice were included. Concatenated voice samples of continuous speech and sustained vowel [a:] were perceptually judged on roughness severity. Acoustic analyses were conducted on the voiced segments of the continuous speech sample plus sustained vowel as well. A stepwise multiple linear regression analysis was applied to construct an acoustic model of the best acoustic predictors. Concurrent validity, diagnostic accuracy, and cross-validation were verified on the basis of Spearman correlation coefficient (rs), several estimates of the receiver operating characteristics plus the likelihood ratio, and iterated internal cross-correlations. Six experts were included for perceptual analysis based on acceptable rater reliability. Stepwise multiple regression analysis yielded a 12-variable acoustic model. A marked correlation was identified between the model and the perceptual judgment (rs = 0.731, P = 0.000). The cross-correlations confirmed a high comparable degree of association. However, the receiver operating characteristics and likelihood ratio results showed the best diagnostic outcome at a threshold of 2.92, with a sensitivity of 51.9% and a specificity of 94.9%. Currently, the newly developed roughness model is not recommended for clinical practice. Further research is needed to detect the acoustic complexity of roughness (eg, multiplophonia, irregularity, chaotic structure, glottal fry, etc).

A Study of Clinicopathological Profile of Patients of Hoarseness of Voice Presenting to Tertiary Care hospital.

Hoarseness is subjective term used to describe abnormal voice quality which may occur due to many causes because it is just a symptom. Proper knowledge and clinicopathological profile is important to treat the underlying pathology. This prospective study was carried out in 100 patients presented in Department of ENT, Gandhi Medical College, Bhopal from April 2013 to September 2014 with complaint of hoarseness of voice for more than 15days. Objective of this study is to study incidence, duration and sex predilection for hoarseness of voice. Also to study different etiological and predisposing factors for hoarseness of voice. After taking detailed history of the patient, complete examination of ear, nose and throat has been carried out. Indirect laryngoscopy, direct laryngoscopy, FOFE is done. Any suspicious tissue is sent for histopathological evaluation. X-ray soft tissue neck and if required CT SCAN larynx is done. Out of 100 patients maximum were from 50 to 70 years age group. 89% were males while only 11% were females. Labourers (37%) and farmers (32%) were the major groups affected. Smoking habit found in 60% of patients and tobacco chewing in 33% of patients and both, also having. Most common cause for hoarseness was found out to be laryngeal neoplasms of which supraglottic growth being commonest (37%) in our study. Hoarseness of voice may be present due to various underlying pathologies. So proper diagnosis, through detailed history, clinical examination and investigations is warranted to find out the cause and starting treatment.

The Evaluation of Abnormal Voice Qualities in Patients with Amyotrophic Lateral Sclerosis

Objective: Voice abnormalities are among the symptoms occurring in patients with amyotrophic lateral sclerosis (ALS). They are divergent and range from hoarseness, through the excessive adduction of false folds, up to the weakness of the vocal folds. The aim of the study was to analyze the phonatory function of the larynx in ALS patients. Methods: Seventeen patients with ALS were evaluated with subjective perceptual voice assessment (including the GRBAS scale), videolaryngostroboscopy including voice range and maximum phonation time (MPT), and objective acoustic voice analysis with IRIS software (including evaluation of jitter, shimmer, mean fundamental frequency, and noise-to-harmonics ratio (NHR)). Examinations were performed three times at 6-month intervals. Results: Hoarseness, roughness, and breathiness of voice were all found more frequently in the majority of these patients. Voice range, amplitude of vibration, mucosal wave, and glottal closure showed significant abnormalities with repeated examinations. MPT was shortened especially among women with ALS. Acoustic analysis of voice among men showed increased jitter value in the first examination only, while jitter, shimmer, and NHR in women with ALS were increased in all examinations. Conclusions: Analysis of voice qualities among patients with ALS allows for the detection of various abnormalities associated with the natural progression of the disease.

Abnormal speech spectrum and increased pitch variability in young autistic children.

Children with autism spectrum disorder (ASD) who can speak often exhibit abnormal voice quality and speech prosody, but the exact nature and underlying mechanisms of these abnormalities, as well as their diagnostic power are currently unknown. Here we quantified speech abnormalities in terms of the properties of the long-term average spectrum (LTAS) and pitch variability in speech samples of 83 children (41 with ASD, 42 controls) ages 4–6.5 years, recorded while they named a sequence of daily life pictures for 60 s. We found a significant difference in the group's average spectra, with ASD spectra being shallower and exhibiting less harmonic structure. Contrary to the common impression of monotonic speech in autism, the ASD children had a significantly larger pitch range and variability across time. A measure of this variability, optimally tuned for the sample, yielded 86% success (90% specificity, 80% sensitivity) in classifying ASD in the sample. These results indicate that speech abnormalities in ASD are reflected in its spectral content and pitch variability. This variability could imply abnormal processing of auditory feedback or elevated noise and instability in the mechanisms that control pitch. The current results are a first step toward developing speech spectrum-based bio-markers for early diagnosis of ASD.

Objective estimation of tracheoesophageal speech ratings using an auditory model

Total laryngectomy is often the treatment of choice for many individuals diagnosed with advanced laryngeal cancer. This procedure alters the normal voice production mechanism, and tracheoesophageal (TE) speech is one alternative method of voicing postlaryngectomy. TE speech is created when pulmonary air is passed through the upper esophagus to create a vibratory source that is then articulated into speech. TE speech is often characterized by abnormal voice quality. Acoustic analysis of TE speech has the potential of quantifying the voice quality and assisting the speech language pathologist in facilitating rehabilitation. Motivated in part by the recent advances in telecommunication industry for speech quality estimation, this paper investigated the application of an auditory model in predicting the ratings of TE speech by normal hearing listeners. The Moore-Glasberg auditory model was employed to extract perceptually relevant features from the acoustic waveform, and these features were later combined to estimate the subjective ratings of TE speech. This approach was validated with a database of subjective ratings of speech samples recorded from 35 TE speakers. Results showed moderate correlations between the objective metrics and the subjective ratings, and these correlations were significantly better than those obtained with traditional methods used in the telecommunication applications.

Perceptual Voice Characteristics in Chronic Cough and Paradoxical Vocal Fold Movement

Voice problems have been reported in chronic cough (CC) and paradoxical vocal fold movement (PVFM), however, there is a lack of a systematic description of voice characteristics in these conditions. This study examined the perceptual voice characteristics of 56 individuals with CC, 8 with PVFM and 55 with both CC and PVFM, compared to 25 people with muscle tension dysphonia (MTD) and 27 healthy controls. There was a high prevalence of abnormal voice quality in the CC and PVFM groups compared with healthy controls. More than one third of participants with CC and PVFM demonstrated strained, rough and/or breathy voices to a moderate or severe degree. The perceptual features in CC and PVFM were similar to those in MTD with greater severity evident in MTD. Possible mechanisms for abnormalities in voice quality include the presence of muscle tension and the frequency of coughing. These results have implications for the identification and management of voice disorders in CC and PVFM and suggest that clinicians should be alert to the incidence of voice abnormalities in these populations.

Discrimination of Pathological Voices Using a Time-Frequency Approach

Acoustical measures of vocal function are routinely used in the assessments of disordered voice, and for monitoring the patient's progress over the course of voice therapy. Typically, acoustic measures are extracted from sustained vowel stimuli where short-term and long-term perturbations in fundamental frequency and intensity, and the level of "glottal noise" are used to characterize the vocal function. However, acoustic measures extracted from continuous speech samples may well be required for accurate prediction of abnormal voice quality that is relevant to the client's "real world" experience. In contrast with sustained vowel research, there is relatively sparse literature on the effectiveness of acoustic measures extracted from continuous speech samples. This is partially due to the challenge of segmenting the speech signal into voiced, unvoiced, and silence periods before features can be extracted for vocal function characterization. In this paper we propose a joint time-frequency approach for classifying pathological voices using continuous speech signals that obviates the need for such segmentation. The speech signals were decomposed using an adaptive time-frequency transform algorithm, and several features such as the octave max, octave mean, energy ratio, length ratio, and frequency ratio were extracted from the decomposition parameters and analyzed using statistical pattern classification techniques. Experiments with a database consisting of continuous speech samples from 51 normal and 161 pathological talkers yielded a classification accuracy of 93.4%.

Perception of synthesized voice quality in connected speech by Cantonese speakers.

Perceptual voice analysis is a subjective process. However, despite reports of varying degrees of intrajudge and interjudge reliability, it is widely used in clinical voice evaluation. One of the ways to improve the reliability of this procedure is to provide judges with signals as external standards so that comparison can be made in relation to these "anchor" signals. The present study used a Klatt speech synthesizer to create a set of speech signals with varying degree of three different voice qualities based on a Cantonese sentence. The primary objective of the study was to determine whether different abnormal voice qualities could be synthesized using the "built-in" synthesis parameters using a perceptual study. The second objective was to determine the relationship between acoustic characteristics of the synthesized signals and perceptual judgment. Twenty Cantonese-speaking speech pathologists with at least three years of clinical experience in perceptual voice evaluation were asked to undertake two tasks. The first was to decide whether the voice quality of the synthesized signals was normal or not. The second was to decide whether the abnormal signals should be described as rough, breathy, or vocal fry. The results showed that signals generated with a small degree of aspiration noise were perceived as breathiness while signals with a small degree of flutter or double pulsing were perceived as roughness. When the flutter or double pulsing increased further, tremor and vocal fry, rather than roughness, were perceived. Furthermore, the amount of aspiration noise, flutter, or double pulsing required for male voice stimuli was different from that required for the female voice stimuli with a similar level of perceptual breathiness and roughness. These findings showed that changes in perceived vocal quality could be achieved by systematic modifications of synthesis parameters. This opens up the possibility of using synthesized voice signals as external standards or "anchors" to improve the reliability of clinical perceptual voice evaluation.

Prevalence of voice disorders among future teachers

An epidemiological study was conducted in order to find out the prevalence of voice disorders among students studying to be teachers. Vocal symptoms were inquired of 226 students. Their voices were assessed perceptually by a speech therapist and those who had abnormal voice quality or reported several vocal symptoms were referred to a clinical examination by a laryngologist. The results showed that 20% of this population reported two or more vocal symptoms during the previous year and that 19% had an organic voice disorder. This reinforces the need for clinical evaluation of students with vocal symptoms and more vocal training in the teacher education programs.

Voice problems after pediatric laryngotracheal reconstruction: videolaryngostroboscopic, acoustic, and perceptual assessment

Children with laryngotracheal stenosis undergo laryngotracheal reconstruction (LTR) to permit tracheostomy decannulation. We conducted voice assessments of 8 pediatric LTR patients with voice problems. Perceptual ratings and acoustic measures were taken in 5 patients and videolaryngoscopy/laryngostroboscopy was conducted in all 8. Results of perceptual evaluation were abnormal for hoarseness, breathiness and pitch. Acoustic analysis revealed a markedly decreased fundamental frequency of phonation, diminished frequency range, decreased vocal intensity, and shortened maximum phonation time. Videolaryngostroboscopic findings are summarized as follows: 2 patients had severe glottal insufficiency, 3 patients had vocal fold asymmetry in stiffness and position, and 3 patients demonstrated phonation using supraglottal structures. Use of the stroboscope contributed to diagnosis in 3 of 8 patients. Reverse (inhalatory) phonation was observed in three patients. Concomitant articulation problems were exhibited frequently. Sentence production was shortened by the decreased phonatory duration. When coupled with the abnormal voice quality, speech intelligibility was significantly affected. Voice problems following decannulation were observed to persist as a long-term difficulty in some LTR patients.

Speech disorders in systemic amyloidosis

The purpose of this study was to define more completely the speech disorders that can occur in systemic amyloidosis. Fifty-nine patients with histologically established primary systemic amyloidosis were studied. Of this group, 81% had abnormal voice quality, 43% had abnormal pitch, 7% had abnormal resonation and 15% had abnormal articulation. Twenty-two patients also had abnormal findings at laryngeal examination, consisting of bowing, oedema, thickening, dry irritation and polypoid changes of the vocal folds. Macroglossia was found in 17% of the patients and submandibular swelling in 10%. These results support previous studies which showed that abnormal phonation is a sign of systemic amyloidosis and that abnormal voice is by far the most common abnormal speech sign. The relationship between amyloid deposit and dysphonia was not clear. In 23 patients who had laryngeal examinations, no evidence of actual amyloid deposits was documented.

Some relations between voice quality judgments and derived acoustic measurements

The use of extracted acoustic features as descriptors of abnormal voice quality was explored by correlating voice quality ratings with the measurements. Sixteen talkers with no history of speech problems and 52 talkers with documented laryngeal pathologies recorded the vowel /ɑ/ using their typical pitch and loudness. Estimates of the excitation for each vowel were obtained using the linear prediction technique of inverse filtering, and the acoustic measurements, known as residue features, were calculated from this waveform. Voice quality estimates were obtained from a panel of judges who rated each vowel on 11 voice quality scales that have been described in the literature. The residue features were used as predictors of average voice quality rating in multiple linear regression analyses. The results are discussed in terms of the voice quality scales that were used most reliably by the judges and the ability of the features to distinguish among various voice quality categories.

Evaluation of a signal-averaging method for the measurement of signal-to-noise ratios in speech

Many abnormal voice qualities are characterized by unusually large amounts of noise. Although the presence of noise is easy to identify, precise quantification of signal-to-noise (S/N) ratios is a difficult problem. Yumoto, Gould and Baer [J. Acoust. Soc. Am. 71, 1544–1550 (1982)] developed a technique based on signal averaging. Using a sustained vowel segmented into pitch periods, the signal component of the S/N calculation is defined as the average of the individual pitch periods. The noise component is estimated by successive subtractions of the average signal from individual pitch periods of the original vowel. In the present study, the accuracy of this technique was evaluated in a series of computer simulations. A synthesized vowel was mixed with varying amounts of synthesized noise. S/N ratios varied over a 36-dB range. Known S/N ratios were compared with S/N ratios calculated by the Yumoto et al. technique. The correlation between calculated and actual S/N ratios was nearly perfect (r = 0.99) and the mean absolute error was only 0.1 dB. Results are also reported for tests involving naturally produced vowels mixed with synthesized noise. [Work supported by NIH.]

Perceptual and acoustic correlates of abnormal voice qualities.

A set of 17 voices representing various voice disorders were presented to a jury of voice experts who rated them on a 5-point scale for each of 28 terms frequently used for describing voices. A statistical treatment of these ratings yielded 5 bipolar factors accounting for 85% of the total variance. Significant correlations were found between four of these factors and certain acoustic data extracted fron long-time-average spectra and fundamental frequency distribution analysis of the same voice sample.