Voice Assessment Research Articles

Introduction of Voice Type Component (VTC) as an Effective Acoustic Voice Analysis Method in Tele-evaluation

Telepractice in voice healthcare and evaluation services has attracted much attention in recent years. Multiple studies have proven the effectiveness of voice therapy with telepractice. However, voice evaluations are still mostly conducted in person due to the lack of sensitive acoustic analysis methods. This study examined various acoustic analysis methods for voice evaluation in telepractice. Eighteen female elementary school teachers with self-reported voice disorders volunteered to participate in the study. Speech samples were collected before and after the interventions using two voice sampling methods concurrently. One set of data was collected using the traditional voice sample collection method by the therapist in person. The second set of data was collected on the same speech samples using the clients' own smartphones, and the collected voice samples were later sent to the researcher for further acoustic analysis. The voice type component (VTC) measurement represented the proportion of different VTCs in a voice by measuring the chaos and intrinsic dimension. Voice analyses were conducted on both sets of data, and the correlation between the two sampling procedures was analyzed. It appears that the VTC could be a more reliable method for producing acoustic analysis results with voice samples collected from smartphones compared to other objective voice assessment procedures. This reliability has been demonstrated via statistical analysis, including correlation coefficient, pairwise t test, d-prime,and area under the curve. The results of this study highlighted the VTC as an effective and accurate acoustic analysis method in tele-evaluation. This feasible voice sampling method, which utilizes participants' own smartphones, will reduce barriers to accessing limited voice specialists due to distance and will decrease the cost of care by minimizing expenses associated with travel and additional equipment for voice sampling. Ultimately, this approach will enhance the effectiveness of voice care delivered through telepractice to patients in remote and underserved areas.

Extent and Effect of Covering Laryngeal Structures with Synthetic Laryngeal Mucus via Two Different Administration Techniques

The first goal of this study was to investigate the coverage of laryngeal structures using two potential administration techniques for synthetic mucus: inhalation and lozenge ingestion. As a second research question, the study investigated the potential effects of these techniques on standardized voice assessment parameters. Fluorescein was added to throat lozenges and to an inhalation solution to visualize the coverage of laryngeal structures through blue light imaging. The study included 70 vocally healthy subjects. Fifty subjects underwent administration via lozenge ingestion and 20 subjects performed the inhalation process. For the first research question, the recordings from the blue light imaging system were categorized to compare the extent of coverage on individual laryngeal structures objectively. Secondly, a standardized voice evaluation protocol was performed before and after each administration to determine any measurable effects of typical voice parameters. The administration via inhalation demonstrated complete coverage of all laryngeal structures, including the vocal folds, ventricular folds, and arytenoid cartilages, as visualized by the fluorescent dye. In contrast, the application of the lozenge predominantly covered the pharynx and laryngeal surface toward the aryepiglottic fold, but not the inferior structures. All in all, the comparison before and after administration showed no clear effect, although a minor deterioration of the acoustic signal was noted in the shimmer and cepstral peak prominence after the inhalation. Our findings indicate that the inhalation process is a more effective technique for covering deeper laryngeal structures such as the vocal folds and ventricular folds with synthetic mucus. This knowledge enables further in vivo studies on the role of laryngeal mucus in phonation in general, and how it can be substituted or supplemented for patients with reduced glandular activity as well as for heavy voice users.

The voice characterisation checklist: psychometric properties of a brief clinical assessment of voices as social agents.

There is growing interest in tailoring psychological interventions for distressing voices and a need for reliable tools to assess phenomenological features which might influence treatment response. This study examines the reliability and internal consistency of the Voice Characterisation Checklist (VoCC), a novel 10-item tool which assesses degree of voice characterisation, identified as relevant to a new wave of relational approaches. The sample comprised participants experiencing distressing voices, recruited at baseline on the AVATAR2 trial between January 2021 and July 2022 (n = 170). Inter-rater reliability (IRR) and internal consistency analyses (Cronbach's alpha) were conducted. The majority of participants reported some degree of voice personification (94%) with high endorsement of voices as distinct auditory experiences (87%) with basic attributes of gender and age (82%). While most identified a voice intention (75%) and personality (76%), attribution of mental states (35%) to the voice ('What are they thinking?') and a known historical relationship (36%) were less common. The internal consistency of the VoCC was acceptable (10 items, α = 0.71). IRR analysis indicated acceptable to excellent reliability at the item-level for 9/10 items and moderate agreement between raters' global (binary) classification of more vs. less highly characterised voices, κ = 0.549 (95% CI, 0.240-0.859), p < 0.05. The VoCC is a reliable and internally consistent tool for assessing voice characterisation and will be used to test whether voice characterisation moderates treatment outcome to AVATAR therapy. There is potential wider utility within clinical trials of other relational therapies as well as routine clinical practice.

Эффект социальной тревоги и стыда в развитии голосов: метакогнитивная обработка неблагоприятного опыта отношений и бдительность к социальным угрозам

&lt;p style="text-align: justify;"&gt;Contemporary representations of auditory hallucinations have intensified the assessment of voices as meaningful representations of the stress of interpersonal traumatic experiences. The aim of the study was to verify the relationship between social anxiety, voices, shame, and metacognitive strategies and to examine the features of attention distortion and cognitive activity in a conflict task using social-emotional stimuli and feedback in social anxiety. The total sample consisted of 122 individuals (32 males and 90 females; M&lt;sub&gt;age&lt;/sub&gt;=26.11, SD&lt;sub&gt;age&lt;/sub&gt;=8.60). The clinical group consisted of 49 persons with subpsychotic (n=28; 7 men and 21 women, M&lt;sub&gt;age&lt;/sub&gt;=24.54, SD&lt;sub&gt;age&lt;/sub&gt;=5.59) and psychotic symptoms (n=21, 12 men and 9 women, M&lt;sub&gt;age&lt;/sub&gt;=28.64, SD&lt;sub&gt;age&lt;/sub&gt;=11.14). The nonclinical group consisted of 73 subjects (13 men and 60 women, M&lt;sub&gt;age&lt;/sub&gt;=25.58, SD&lt;sub&gt;age&lt;/sub&gt;=8.51). In both groups, subjects reliably reported thinking objectification, dissociative phenomena, and voices. A subgroup (n=31, 10 men and 21 women, M&lt;sub&gt;age&lt;/sub&gt;=19.87, SD&lt;sub&gt;age&lt;/sub&gt;=1.22) was selected to participate in the experiment, divided by the level of social anxiety: high (n=16, 4 men and 12 women, M&lt;sub&gt;age&lt;/sub&gt;=19.96, SD&lt;sub&gt;age&lt;/sub&gt;=1.14) and low (n=15, 6 men and 9 women, M&lt;sub&gt;age&lt;/sub&gt;=19.34, SD&lt;sub&gt;age&lt;/sub&gt;=1.05). The following techniques were used: Russian-language versions of the Thought Suppression and Rumination Scale (adapted by Dorosheva, Knyazev, 2017); the Fear of Negative Evaluation Scale (adapted by Grigorieva, Enikolopov, 2016); author's Psychotic Experiences Questionnaire (2023), Social Anxiety and Social Anxiety Disorder Questionnaire (2016) and Self-Focused Attention Questionnaire (2016). After the diagnosis of psychological parameters, an eye-tracking experiment was conducted using a modified flanking Ericksen task. It was found that thought suppression (F&lt;sub&gt;(1;120)&lt;/sub&gt;=11.11; p=0.001), rumination (F&lt;sub&gt;(1;120)&lt;/sub&gt;=7.43; p=0.01), self-focused attention (F&lt;sub&gt;(1;120)&lt;/sub&gt;=3.85; p=0.05), social anxiety (F&lt;sub&gt;(1;120)&lt;/sub&gt;=7.30; p=0.01), and shame (F&lt;sub&gt;(1;120)&lt;/sub&gt;=21.62; p&amp;lt;0.001) than in the absence of such experiences. We obtained a two-factor solution (each factor explains 30% of the variance) reflecting metacognitive pathways of voice formation: 1) self-focus supports social anxiety, shame, a tendency to suppress thoughts, and the emergence of voices; 2) pronounced thought suppression and rumination associated with shame increase the likelihood of voices, with the detectability of social anxiety attenuated. Significant differences (p&amp;lt;0.001) were found between the high and low social anxiety groups in the parameters of eye-movement and behavioral activity in the eye-tracking experiment (e.g., total test passage time, total number of fixations, response time after a mistaken decision, number of fixations of the off-target stimulus &amp;mdash; the central face &amp;mdash; and the target stimulus). The conclusion is that further research is needed to clarify the direction of the relationship between psychological parameters and voice experience.&lt;/p&gt;

Effects of Speech and Language Therapists’ Personality Traits and Cognitive Emotion Regulation on the Perceptual Evaluation of Dysphonia

As in many healthcare fields, it is essential to establish clinical standards for voice assessments; however, some individual characteristics of clinicians, such as their personalities, may affect assessment reliability. Therefore, this study aims to examine the relationship between the personality traits and cognitive emotion regulation strategies of speech-language therapists (SLTs) and their GRBAS (Grade, Roughness, Breathiness, Asthenia, Strain) scoring. The study group comprised 33 SLTs and 9 women with dysphonia. The Five-Factor Personality Inventory (FFPI) and Cognitive Emotion Regulation Questionnaire (CERQ) were used to assess SLTs' psychological traits. The SLTs evaluated the acoustic recordings of sustained vowel phonation /a/ obtained from individuals with dysphonia, using the GRBAS scale. Cronbach's alpha was used to assess inter-rater reliability, and Spearman's correlation analysis was used to analyze the relationships among the variables. The findings revealed that the FFPI dimensions were weakly and significantly related to Grade (G) and Strain (S). In the maladaptive dimensions, with an increase in the scores of the neuroticism dimension of FPPI and the catastrophizing dimension of CERQ, the SLTs gave significantly higher scores to Grade (G). In addition, with an increase in the score of rumination or focus on thought, the SLTs perceived Strain (S) more negatively. Consistent with these findings, in the adaptive dimensions, the SLTs gave higher scores to Grade (G) as the positive refocusing and positive reappraisal scores decreased. The findings of this study showed that, as some maladaptive aspects of personality and cognitive emotion regulation increased and adaptive aspects decreased, the SLTs' perceptions of Grade (G) and Strain (S) became more negative. Additionally, these results suggested the possibility of advanced confounding variables beyond primary factors, such as training and experience in the perceptual voice assessment of the SLTs, and the importance of standardizing professional practices, such as the observation and supervision of experts.

Comparison and Relation Between Vocal Tract Discomfort and Voice Handicap Index in Teachers With and Without Muscle Tension Dysphonia

Objective One of the most voice-related complaints in teachers is vocal tract discomfort (VTD) which can increase the voice handicap index (VHI) to different degrees. In teachers Muscle Tension Dysphonia (MTD), increases voice complaints and decreases the voice-related quality of life. The aims of this study were to evaluate and compare the frequency and severity subscales of the VTD score and total score of VHI and determine the relation between them in primary school teachers with and without MTD. Materials &amp; Methods This study was cross-sectional and was performed on 80 primary female teachers with and without MTD. The participants in both groups were randomly selected after checking the inclusion criteria. Voice history, auditory-perceptual assessment of voice, palpation, and laryngeal video-stroboscopy were assessed on the teachers in two groups. Then, asked the participants to complete the Persian versions of the VTD and VHI scales. After determining the normal distribution of the data using the Kolmogorov-Smirnov test, the results of VTD, VHI, and their subscales were compared between two groups with an independent t-test. Also, the relationship between them was assessed with the Pearson correlation coefficient analysis. Results The mean score of the frequency subscale of VTD in teachers with MTD was more than in teachers without MTD (30.17±5.11, 8.22±2.26), respectively. The score of severity subscales of VTD in teachers with MTD was 39.12±4.94 and in teachers without MTD was 7.89±2.13. Also, the total score of the VHI questionnaire in teachers with MTD was significantly higher than teachers without MTD (P&lt;0.05). Moreover, there was a significant positive correlation between the frequency and severity subscales of VTD and the total score of VHI in the two groups (P&lt;0.05). Conclusion This study showed the frequency and severity scores of the VTD and the degree of VHI experienced by MTD are remarkably higher than teachers without MTD. The authors emphasize on the use of VTD and VHI scales in screening teachers who are at risk of voice problems, and the researchers pointed out the importance of paying attention to the reduction of discomfort feelings in the vocal tract and voice handicap in the voice therapy sessions of teachers with MTD.

Determining Cutoff Point in Bahasa Malaysia Version of Voice Handicap Index-10 (mVHI-10)

Determining the cutoff point on Bahasa Malaysia version of Voice Handicap Index (mVHI-10) questionnaire scores for distinguishing between dysphonic and normal voice samples. A cross-sectional study was conducted in the tertiary hospital, Otorhinolaryngology-Head and Neck clinic. The study involved 205 subjects (105 in the dysphonia group; 100 in the normal group) with a complete database of flexible laryngoscopy/stroboscopy, voice recording, acoustic analysis, and mVHI-10 score. A sample with a discrepancy between subjective evaluation and acoustic analysis results was excluded from the study. Each classified dataset matched with the respective mVHI-10 questionnaire score. Finally, all the collected data were subjected to data analysis. The best cutoff point for mVHI-10 was 7.5 by the receiver operating characteristiccurve, with an area under the curve value of 0.997. Its sensitivity, specificity, positive predictive value, and negative predictive value were 92.4%, 100.0%, 100.0%, and 93.0%, respectively. The best cutoff point for mVHI-10 is 7.5, as determined by stringent data evaluation and rigorous statistical analysis. With excellent diagnostic accuracy properties, it enhances the usage of the mVHI-10 questionnaire as an excellent screening tool. Nevertheless, we advocate multidimensional voice assessment for diagnostic purposes.

Reliability of Universal-Platform-Based Voice Screen Application in AVQI Measurements Captured with Different Smartphones.

The aim of the study was to develop a universal-platform-based (UPB) application suitable for different smartphones for estimation of the Acoustic Voice Quality Index (AVQI) and evaluate its reliability in AVQI measurements and normal and pathological voice differentiation. Our study group consisted of 135 adult individuals, including 49 with normal voices and 86 patients with pathological voices. The developed UPB "Voice Screen" application installed on five iOS and Android smartphones was used for AVQI estimation. The AVQI measures calculated from voice recordings obtained from a reference studio microphone were compared with AVQI results obtained using smartphones. The diagnostic accuracy of differentiating normal and pathological voices was evaluated by applying receiver-operating characteristics. One-way ANOVA analysis did not detect statistically significant differences between mean AVQI scores revealed using a studio microphone and different smartphones (F = 0.759; p = 0.58). Almost perfect direct linear correlations (r = 0.991-0.987) were observed between the AVQI results obtained with a studio microphone and different smartphones. An acceptable level of precision of the AVQI in discriminating between normal and pathological voices was yielded, with areas under the curve (AUC) displaying 0.834-0.862. There were no statistically significant differences between the AUCs (p > 0.05) obtained from studio and smartphones' microphones. The significant difference revealed between the AUCs was only 0.028. The UPB "Voice Screen" application represented an accurate and robust tool for voice quality measurements and normal vs. pathological voice screening purposes, demonstrating the potential to be used by patients and clinicians for voice assessment, employing both iOS and Android smartphones.

Utility of Smart Phones as a Voice Acquisition Device for Assessing Pre and Post Treatment Voice Using PRAAT.

Voice assessment before and after treatment helps the clinician to assess the effectiveness of the treatment given and facilitates comparison between different treatment modalities. Voice handicap index -10(VHI-10) questionnaire is a tool which allows the voice to be evaluated subjectively from the patient's perspective. PRAAT is a freely available, software programme that acoustically analyse voice signals. Smart phones are widely used and the high quality of the embedded microphone in it makes it a suitable and easily available voice recording device. This study aims at using PRAAT and VHI-10 questionnaire in evaluating voice before and after treatment. The utility of smart phones as a voice acquisition device is also explored in the study. Prospective, observational study, carried out from 1st November 2019 to 30th September 2021in the ENT out- patient department at a tertiary hospital in Punjab. 58 patients complaining of dysphonia were enrolled consecutively in the study. All patients underwent detailed history, examination of the larynx using 70-degree rigid laryngoscope. The voice handicap was scored by (VHI-10) questionnaire and acoustic evaluation of voice was done using the PRAAT software. Patients' voice was further evaluated 3months post-therapy with VHI 10 questionnaire and acoustic analysis. The parameters measured on PRAAT were mean pitch, jitter (local), shimmer (local), and mean harmonics to noise ratio (HNR). The voice was recorded using a smart phone and later transferred onto a laptop for analysis. The pre and post treatment acoustic parameters and VHI-10 scores were compared and correlated. There was significant difference (p < 0.001) between the pre and post treatment VHI-10 scores and all the acoustic parameters measured except for median pitch (p = 0.995). A poor positive correlation was found between the pre treatment VHI-10 scores and jitter(r = 0.188, p = 0.157) and shimmer (r = 0.288, p = 0.028) values. A negative correlation was observed between pre treatment VHI-10 scores and pitch (r = -0.151, p = 0.259) and HNR(r = -0.424, p = 0.001). Post treatment VHI-10 scores showed positive correlation with jitter (r = 0.302, p = 0.021) and shimmer (0.162, p = 0.225) values and negative correlation with pitch (r = -0.10, p = 0.457) and HNR (r = -0.356, p = 0.006) values. We found significant differences in the VHI-10 scores and PRAAT voice analysis results before and after treatment in patients complaining with voice change (dysphonia). VHI-10 questionnaire and PRAAT are good and convenient tools for assessing the voice subjectively and objectively. Only a poor to fair correlation was found between VHI-10 scores and PRAAT analysis results. More studies must be done to confirm the utility of smart phones as a voice acquisition device and PRAAT software in voice analysis.

Mitigation of Respirable Aerosol Particles from Speech and Language Therapy Exercises

Phonation and speech are known sources of respirable aerosol in humans. Voice assessment and treatment manipulate all the subsystems of voice production, and previous work (Saccente-Kennedy et al., 2022) has demonstrated such activities can generate >10 times more aerosol than conversational speech and 30 times more aerosol than breathing. Aspects of voice therapy may therefore be considered aerosol generating procedures and pose a greater risk of potential airborne pathogen (eg, SARS-CoV-2) transmission than typical speech. Effective mitigation measures may be required to ensure safe service delivery for therapist and patient. To assess the effectiveness of mitigation measures in reducing detectable respirable aerosol produced by voice assessment/therapy. We recruited 15 healthy participants (8 cis-males, 7 cis-females), 9 of whom were voice-specialist speech-language pathologists. Optical Particle Sizers (OPS) (Model 3330, TSI) were used to measure the number concentration of respirable aerosol particles (0.3 µm-10 µm) generated during a selection of voice assessment/therapy tasks, both with and without mitigation measures in place. Measurements were performed in a laminar flow operating theatre, with near-zero background aerosol concentration, allowing us to quantify the number concentration of respiratory aerosol particles produced. Mitigation measures included the wearing of Type IIR fluid resistant surgical masks, wrapping the same masks around the end of straws, and the use of heat and moisture exchange microbiological filters (HMEFs) for a water resistance therapy (WRT) task. All unmitigated therapy tasks produced more aerosol than unmasked breathing or speaking. Mitigation strategies reduced detectable aerosol from all tasks to a level significantly below, or no different to, that of unmasked breathing. Pooled filtration efficiencies determined that Type IIR surgical masks reduced detectable aerosol by 90%. Surgical masks wrapped around straws reduced detectable aerosol by 96%. HMEF filters were 100% effective in mitigating the aerosol from WRT, the exercise that generated more aerosol than any other task in the unmitigated condition. Voice therapy and assessment causes the release of significant quantities of respirable aerosol. However, simple mitigation strategies can reduce emitted aerosol concentrations to levels comparable to unmasked breathing.

Clinical Experiences of Speech-Language Pathologists in the Rehabilitation of Unilateral Vocal Fold Paralysis

Unilateral vocal fold paralysis (UVFP) is a neurological voice disorder that is often first treated by a speech-language pathologist (SLP). In literature, little consensus is found regarding voice therapy onset, duration, frequency, and content. The aim of the current study is to investigate the clinical practice of SLPs for treatment of UVFP regarding diagnostics and treatment characteristics. Additionally, the study examined the personal experiences of SLPs regarding UVFP care. An online survey was completed by 37 respondents, all SLPs with experience in treating UVFP. Demographic characteristics, experiences with voice assessments and treatment modalities were examined. Lastly, experiences and opinions of SLPs on evidence-based practice and their own clinical practice were surveyed. Almost all respondents used a multidimensional voice assessment with findings from laryngovideostroboscopy to assess UVFP. Laryngeal electromyography is not yet integrated in regular clinical practices. The most commonly used vocal techniques were resonant voice exercises, laryngeal manipulation, semioccluded vocal tract exercises (SOVTEs), vocal hygiene, and Vocal Function Exercises, with SOVTEs most often considered effective. A total of 75% of the respondents feel confident treating UVFP, and 87.6% believe it is important to stay updated on evidence-based practice. Variation in therapy timing and dosage was observed, and 48.4% of SLPs usually started early voice therapy within 4 weeks after UVFP onset. Flemish SLPs generally feel confident treating UVFP patients and show interest in improving evidence-based practice. Initiatives to train clinicians further in UVFP care and encouraging SLPs to provide practice-based evidence will enhance the knowledge base for evidence-based practice in UFVP.

Relationship Between Vocal Fatigue Index and Acoustic Voice Scales in Patients With Coronavirus Infection

The voice quality of patients with Coronavirus Disease 2019 (COVID-19) seems to be affected due to lower and upper respiratory involvement. Patient-based voice assessment scales are important clinical measures to diagnose voice disorders and monitor treatment outcomes in COVID-19 patients. This study compared vocal fatigue between COVID-19 patients and those with normal voices. Furthermore, the relationship between vocal fatigue and acoustic voice parameters of COVID-19 patients was evaluated. This cross-sectional study enrolled 30 laboratory-confirmed patients with COVID-19 (18 males and 12 females) and 30 healthy individuals with normal voices (14 males and 16 females) to compare their respiratory or phonatory parameters. The Persian versions of the Consensus Auditory Perceptual Evaluation of Voice (CAPE-V) and the vocal fatigue index (VFI) were conducted before and after reading the text. The Jitter, shimmer, maximum phonation time, and harmonic-to-noise ratio (HNR) were analyzed by Praat software based on the recorded voices of CAPE-V tasks. The acoustic assessment and VFI questionnaire results were compared between COVID-19 patients and the control group. There were significant differences between COVID-19 patients and their healthy counterparts in all VFI subscales (P<0.001). Moreover, after reading the text, we found significant differences between the two groups regarding Jitter, shimmer, and HNR of /a/ and /i/ vowels (P<0.05). Our findings also indicated a significant correlation between symptom improvement with rest and acoustic parameters in all tasks, except the Jitter of /a/ before reading the text. Patients with COVID-19 showed significantly more vocal fatigue than people with normal voices after reading the text. Moreover, there was a significant relationship between Jitter, shimmer, and HNR and the tiredness of voice and physical discomfort subscales of VFI.

Acoustics Features of Voice in Adolescent Females With Anorexia Nervosa

The process of human voice production is a complex physiological and acoustic phenomenon that depends on many structural, physical, and hormonal factors, systemic diseases as well as emotional states. All these factors can be present in eating disorders. However, studies on eating disorders and voice problems have usually been evaluated in terms of bulimia. Chronic starvation and emotional problems in the course of anorexia nervosa (AN) appear to be under-researched, despite various biochemical, metabolic, and hormonal changes. The purpose of this study was to evaluate voice quality, specifically acoustic analysis, in adolescent female with AN from the point of view of the possible influence on the function and structure of the larynx, low body mass accompanying AN, as well as energy deficiency, hormonal and emotional disturbances. A total of 84 girls diagnosed with AN (Gr.A) (15.32 years, SD=2.12; range 12-19, BMI=14.11±1.72)were assessed for the condition of the voice such as perceptual voice evaluation on the GRBAS scale, maximal phonation time (MPT), laryngoscopy, with special attention to voice acoustic analysis - Multi-Dimensional Voice Program (MDVP). The control group (Gr.C) included 62 girls without eating disturbances (aged 12-19, mean age 15.41±2.40, BMI=21.60±1.92). Perceptual voice assessment, aerodynamic test MPT, and acoustic parameters were analyzed according to girls' age. Total GRBAS scale was higher in girls with AN compared to the control group mainly for two parameters: breathiness (B) (P=0.00015) and asthenia (A) (P<0.05). TheMPT for Gr.A was significantly shorter compared to Gr.C (15.40±3.51seconds vs. 23.19±5.17seconds) (P<0.001), and a correlation of MPT values with the age of the adolescent female was observed: Spearman's coefficient for Gr.A=(-)0.5378, for Gr.C=0.5516 (P=0.0012). Acoustic analysis revealed the decrease in the basic frequency F0 in Gr.A compared to Gr.C (231.08Hz vs. 242.30Hz), and narrowing of the voice scale was observed, resulting mainly from a reduction in the upper limit. Significant differences were found for measures of frequency perturbations (Jita, Jitter, RPA, PPQ, sPPR), with Gr.A scoring significantly higher than Gr.C (P<0.05 for all). Significant changes in voice acoustic analysis parameters were found with age. Negative correlations were found for measures of F0 for Gr.A to a much greater extent compared to Gr.C. Positive correlations were found with measures of tremor assessment (SPI, FTRI, ATRI) for Gr.A.

Pareto-Optimized AVQI Assessment of Dysphonia: A Clinical Trial Using Various Smartphones

Multiparametric indices offer a more comprehensive approach to voice quality assessment by taking into account multiple acoustic parameters. Artificial intelligence technology can be utilized in healthcare to evaluate data and optimize decision-making processes. Mobile devices provide new opportunities for remote speech monitoring, allowing the use of basic mobile devices as screening tools for the early identification and treatment of voice disorders. However, it is necessary to demonstrate equivalence between mobile device signals and gold standard microphone preamplifiers. Despite the increased use and availability of technology, there is still a lack of understanding of the impact of physiological, speech/language, and cultural factors on voice assessment. Challenges to research include accounting for organic speech-related covariables, such as differences in conversing voice sound pressure level (SPL) and fundamental frequency (f0), recognizing the link between sensory and experimental acoustic outcomes, and obtaining a large dataset to understand regular variation between and within voice-disordered individuals. Our study investigated the use of cellphones to estimate the Acoustic Voice Quality Index (AVQI) in a typical clinical setting using a Pareto-optimized approach in the signal processing path. We found that there was a strong correlation between AVQI results obtained from different smartphones and a studio microphone, with no significant differences in mean AVQI scores between different smartphones. The diagnostic accuracy of different smartphones was comparable to that of a professional microphone, with optimal AVQI cut-off values that can effectively distinguish between normal and pathological voice for each smartphone used in the study. All devices met the proposed 0.8 AUC threshold and demonstrated an acceptable Youden index value.

Immediate effects of a semi-occluded water-resistance ventilation mask on vocal outcomes in women with dysphonia

IntroductionSemi-occluded vocal tract exercises (SOVTEs) are frequently used exercises in voice therapy. An important shortcoming to most SOVTEs is the inability to include continuous speech in these exercises. A variation of water-resistance therapy (WRT), during which a patient phonates through a resonance tube ending in water, was developed to include continuous speech: the semi-occluded water resistance ventilation mask (SOVM-WR). The current study investigated the immediate effects of this innovative technique on vocal outcomes of women with dysphonia. MethodsA pretest-posttest randomized controlled trial was performed. Twenty female participants were randomly assigned to the experimental SOVM-WR group or the WRT (control) group. A blinded multidimensional voice assessment was conducted before and after a 30-minute therapy session with the assigned technique. ResultsNo significant changes were found in acoustic or auditory-perceptual vocal outcomes in either of the groups, except for a significant increase in lowest frequency in both groups. Patient-reported outcomes (PROMs) showed significant improvements of vocal comfort, vocal effort, and voice quality in both groups, and participants indicated that they would use the techniques at home. ConclusionsThe similar results of the SOVM-WR to WRT and promising PROMs confirm its suitability as an alternative to the latter technique. Potential reasons for a lack of improvement of objective and auditory-perceptual vocal outcomes are vocal fatigue, tube dimensions and immersion, and the small sample size. Large-scale and longitudinal research is needed to examine whether the SOVM-WR has a higher transfer to spontaneous speech than WRT after a full therapy program.

ONLINE SPEAKING ASSESSMENT DURING THE COVID PANDEMIC:

Assessment is one of the basic elements of the teaching and learning process. With assessment, teachers can measure students' abilities. Teachers can measure the competencies that students achieve during the teaching process. In this pandemic era, the activity of the teaching process does not apply in the classroom. However, the teaching process can be applied online using technology. The objectives of this study are: (1) For the online voice assessment feature; (2) Investigate the implementation of online assessment of speaking skills in vocational schools; (3) Research the gaps and solutions to overcome the gaps in the implementation of online voice assessment in the pandemic era with 21st century skills. This study uses a qualitative model description to investigate the case design. The researcher collects data through interviews. The interview was conducted with an English teacher who teaches grade 12 of one of the SMKN in Kota Cirebon. The results of this study showed that the implementation of online speaking skills assessment is using WhatApp as a means of communication in the learning and assessment process, and speaking tasks are guided by using video dialogues and video presentations. The problems experienced by teachers in carrying out online speaking assessment are students' ability to think critically and responsibility to perform and fulfil the tasks; the limited media used in the online speaking skills assessment which is just WhatsApp, the kind of speaking task that is not compatible with 21st century skills. Then there are solutions to counter those problems are by teachers motivating students, guiding students in critical thinking and last but not least the role of government in developing and introducing how to use online platforms.

Perceptual and Acoustical assessment of voice in children with cleft lip and palate

BACKGROUND: The speech of individuals with cleft lip and palate is primarily characterized by nasality of oral speech because of cleft and or velopharyngeal dysfunction. OBJECTIVES: The aim of the present study is to investigate the acoustical assessment and perceptual rating measurements in cleft lip and palate children. METHODS: The study participants included 30 children with cleft lip and palate in the age range of 4 to 12 years. Prior parental consent was obtained for the inclusion of their children in the study. Speech samples of all the l the participants were recorded. Prerecorded speech samples of the individuals of the CLP groups were mixed and randomized and played,using headphone conditions in a quiet room. The SLPs speech language pathologists rated the nasality of the participant. Samples given for perceptual evaluation are 15 phonation samples of /ă/, /ɪ/ and /ŭ/ vowels vowel, 15 conversation samples and 30 subjects (3 oral sentences each so total 90 sentences). RESULTS: For the Phonation sample, SLP must evaluate the presence of hypernasality by Wilcoksons nasality scale. Acoustic analysis was done using PRAAT software. The spectral and temporal parameters were measured. The Kappa coefficient was 0.88 for inter-rater reliability for nasality rating scale, 0.82 for speech intelligibility,1.02 for speech understandability,1.00 for speech acceptability, which suggests substantial agreement between the raters for four different rating scales. CONCLUSION: Thus, to conclude in children with cleft lip and palate both acoustical and perceptual evaluation plays an important role while assessing the speech domain by using different kinds of speech stimuli.

Laryngeal sensory neuropathy caused by COVID-19: findings using laryngeal electromyography

PurposeLaryngeal sensory neuropathy (LSN) is caused by a disorder of the superior laryngeal nerve or the recurrent laryngeal nerve. A diagnosis of LSN should include laryngeal electromyography (LEMG) and laryngovideostroboscopy (LVS). The aim of this study was to characterize the physical and subjective symptoms of neuropathy in patients diagnosed with LSN following COVID-19.Material and methodsSince the beginning of the COVID-19 pandemic, 6 patients who had recovered from the disease presented to us with LSN symptoms. All patients underwent laryngological and phoniatric examination, objective and subjective voice assessment, and LEMG.ResultsThe most common LSN symptom reported by patients was periodic hoarseness of varying severity. Other common symptoms were the sensation of a foreign body in the throat and voice fatigue. Endoscopy often showed functional abnormalities. The LSN patients could be characterized by LEMG recordings, and all showed abnormal activity of the cricothyroid (CT) muscle. The degree of EMG changes in the CT correlated moderately with the severity of dysphonia.ConclusionsSensory neuropathy of the larynx may be a long-lasting complication of SARS-COV-2 infection. The severity of EMG neuropathic changes in the CT muscle broadly corresponds to the severity of dysphonia.

Relationship Between Auditory-Perceptual and Objective Measures of Resonance in Children with Cleft Palate: Effects of Intelligibility and Dysphonia.

To investigate the relationship between auditory-perceptual ratings of resonance and nasometry scores in children with cleft palate. Factors which may impact this relationship were examined including articulation, intelligibility, dysphonia, sex, and cleft-related diagnosis. Retrospective, observational cohort study. Outpatient pediatric cranio-facial anomalies clinic. Four hundred patients <18 years of age identified with CP ± L, seen for auditory-perceptual and nasometry evaluations of hypernasality as well as assessments of articulation and voice. Relationship between auditory-perceptual ratings of resonance and nasometry scores. Pearson's correlations indicated that auditory-perceptual resonance ratings and nasometry scores were significantly correlated across oral-sound stimuli on the picture-cued portion of the MacKay-Kummer SNAP-R Test (r values .69 to.72) and the zoo reading passage (r = .72). Linear regression indicated that intelligibility (p ≤ .001) and dysphonia (p = .009) significantly impacted the relationship between perceptual and objective assessments of resonance on the Zoo passage. Moderation analyses indicated that the relationship between auditory-perceptual and nasometry values weakened as severity of speech intelligibility increased (P < .001) and when children presented with moderate dysphonia (p ≤ .001). No significant impact of articulation testing or sex were observed. Speech intelligibility and dysphonia alter the relationship between auditory-perceptual and nasometry assessments of hypernasality in children with cleft palate. SLPs should be aware of potential sources of auditory-perceptual bias and shortcomings of the Nasometer when following patients with limited intelligibility or moderate dysphonia. Future study may identify the mechanisms by which intelligibility and dysphonia affect auditory-perceptual and nasometry evaluations.

The effect of wearing face masks on voice and intelligibility of speech during the COVID-19 pandemic

BackgroundThe study aims at evaluating the effect of wearing face masks on voice and intelligibility of speech in Egyptian working individuals during the COVID-19 pandemic to identify if there are any adverse effects of wearing face masks in the working environment.Materials and methodsA cross-section analytical study was conducted on 153 participants. Personal data and data about the nature of their workplaces were collected. The evaluation included a subjective assessment of voice and intelligibility of speech using a specifically designed questionnaire addressing self-perception of voice fatigue, speech unintelligibility, received auditory feedback and breathing difficulty, and objective voice assessment by Computerized Speech Lab, while objective speech unintelligibility assessment by the Arabic Speech Intelligibility Test.ResultsThe study revealed poor workplace acoustics and increased their self-perception of voice fatigue, speech unintelligibility, auditory feedback, and breathing difficulty while wearing masks. Medical professionals showed increased self-perception of speech unintelligibility and the received auditory feedback. No significant difference was found in absolute jitter with and without a face mask. Increasing shimmer and mean fundamental frequency and decreasing noise to harmonic ratio and maximum phonation time were found. The study revealed decreased speech intelligibility especially with the N95 mask.ConclusionWearing face masks negatively affects communication in the workplace, with poor room acoustics. It affects both speech intelligibility and voice subjectively and objectively. It caused increased self-perception of voice fatigue and changes in objective voice parameters.