Evaluation Of Voice Quality Research Articles

Female Voice-Related Sexual Attractiveness to Males: Does it Vary With Different Degrees of Conception Likelihood?

Previous investigations have found that female voice-related attractiveness to males increases when both conception likelihood (CL) and voice fundamental frequency (fo) are elevated. To test this hypothesis, we conducted a perceptual experiment where 78 heterosexual males rated sexual attractiveness of 9 female voice samples, recorded at menstrual, follicular and luteal phases of the menstrual cycle under two double-blinded randomly allocated conditions: a natural menstrual cycle (placebo condition) and when using an oral contraceptive pill (OCP condition). The voice samples yielded a total of 54 stimuli that were visually sorted and rated using Visor software. Concentrations of estrogens, progesterone and testosterone were analyzed, and measurements of speaking fundamental frequency (sfo) and its standard deviation (sfoSD), fo derivative (dfo) and fo slope were made. A multilevel ordinal logistic regression model nested in listeners and in females, and adjusted by phase and condition, was carried out to assess the association between ratings and: (1) phases and conditions; (2) sex steroid hormonal concentrations; and (3) voice parameters. A high probability of obtaining high ratings of voice sexual attractiveness was found for: (1) menstrual phase of placebo use and follicular phase of OCP use; (2) for low estradiol to progesterone ratio and testosterone concentrations; and (3) for low dfo. The latter showed a moderate statistical association with ratings of high attractiveness, as compared with the small association found for the remaining variables. It seems that the voice is a weak cue for female CL. Female sexual attraction to males may be a consequence of what females do in order to regulate their extended sexuality across the menstrual cycle rather than of estrus cues, the use of paralinguistic speech patterns being an example.

Acoustic parameters for the evaluation of voice quality in patients with voice disorders.

To investigate the value of the standard deviation of the fundamental frequency (F0 SD), jitter, and shimmer for the evaluation of voice quality and the description of vocal characteristics in patients with voice disorders. This prospective cohort study included 4 groups: vocal cord polyps (VCP) group (n=55), early-stage (stage I-II) laryngeal carcinoma (ELC) group (n=35), mutational falsetto (MF) group (n=17), and a normal control group (n=29). The participants were asked to emit a sustained vowel /a/ and raise the pitch gradually. Acoustic parameters, including F0, F0 SD, jitter, and shimmer, were recorded and analyzed. The F0 SD was highest in the MF group. The F0 SD in the MF group and the ELC group was significantly higher than that in the VCP group and the control group (P<0.05), and the F0 SD in the VCP group was significantly higher than that in the control group (P<0.05). However, there was no significant difference in F0 SD between the MF group and the ELC group (P>0.05). The jitter and shimmer in the ELC group were significantly higher compared to the other groups (P<0.05), and the jitter and shimmer in the VCP group were significantly higher than those in the MF group and the control group (P<0.05). There were no significant differences in jitter or shimmer between the MF group and the control group (P>0.05). F0 SD, jitter, and shimmer are important parameters for the evaluation of pitch variation during sustained phonations, and can discriminate between MF and voice disorders.

Agreement between Transcription- and Rating-Based Intelligibility Measurements for Evaluation of Dysphonic Speech in Noise

ABSTRACT Dysphonia negatively affects a speaker’s intelligibility, especially in noisy environments. Previously, our study showed this effect of dysphonia with the transcription-based intelligibility measurement. While this finding indicates the importance of intelligibility assessment for this population, implementing the transcription-based measurement may be difficult in clinical settings due to its resource-demanding nature. Using the same speakers, this study examined the agreement between transcription- and rating-based intelligibility measurements. Six sentences from the Consensus of Auditory-Perceptual Evaluation of Voice (CAPE-V) were recorded from 18 individuals with dysphonia (6 adult females, 6 adult males, and 6 children). Their dysphonia severity was determined through auditory-perceptual evaluation by two speech-language pathologists. Cafeteria noise was added to these recordings at SNR0 and paired with a sample from a healthy speaker in their age and/or gender group. Forty-five listeners rated intelligibility of the dysphonic samples on a 7-point rating scale. Spearman’s rank correlation tests were conducted to examine the correlations between rating-based intelligibility measurement and the transcription-based measurement from our previous study, as well as the voice quality ratings and the rating-based intelligibility measurements. There was a strong positive correlation between the transcription- and rating-based measurements at all noise levels. The correlation between rating-based intelligibility measurement and breathiness rating was also strong. Our findings suggest that the rating-based intelligibility measurement could potentially be used as a substitute for the transcription-based analysis. Furthermore, the intelligibility deficit may be particularly problematic to patients who present with breathy dysphonia.

Treatment efficacy of electronic endoscope-guided botulinum toxin injection in adductor spasmodic dysphonia patients

Objective:To investigate the treatment efficacy of electronic endoscope-Guided botulinum toxin injection in Adductor Spasmodic Dysphonia Patients. Method:Clinical characteristics of forty- three cases were retrospectively analyzed. The disease were diagnosed with adductor spasmodic dysphonia and graded according to the severity of the disease by experienced voice specialist. All the cases were treated by electronic endoscope-guided botulinum toxin type A injection in bilateral thyroarytenoid muscles. All the subjects underwent stroboscopic laryngoscope examination and filled in the Voice Handicap Index-10（VHI-10）. They also filled in the VAS score of Voice related symptoms by self evaluation and other evaluation . One month Later, the patients and someone they lived with filled in the VAS score of Voice related symptoms again. Result:After the first injection, the voice-related symptoms of 35 patients improved to varying degrees..All The average onset time of drug was（2.33±1.86） days. The duration of curative effect ranged from 1 to 6 months, the average duration was（2.42±1.65） months. After injection, no one had serious or persistent adverse reactions. There were significant differences in the total score of VHI-10, physiology（P） and function（F） dimensions in VHI-10 of moderate and severe SD patients before and after injection（P<0.05） in all patients. For moderate cases, no significant change in speech articulation（P>0.05）, overall evaluation of voice quality and any other subprojects are statistically significant（P<0.05） in the VAS score of Voice related symptoms; For severe cases, the degree of squeezing and effort during vocalization are no statistically significant（P>0.05）, overall evaluation of voice quality and any other subitems are statistically significant（P<0.05） in the VAS score of Voice related symptoms. Conclusion:In the absence of LEMG, electronic endoscope-guided botulinum toxin injection in adductor spasmodic dysphonia patients can significantly improve the voice quality and quality of life of adductive SD patients. The method is simple to operate, less traumatic, safe and effective, and easy to carry out outpatients service.

Validation and Test-Retest Reliability of Acoustic Voice Quality Index Version 02.06 in the Turkish Language

The aim of the present study was to investigate the validity (both concurrent and diagnostic) and test-retest reliability of Acoustic Voice Quality Index (AVQI) version 2 (AVQI 02.06) in Turkish speaking population. Two hundred and fifty five native Turkish subjects with normal voices (n=128) and with voice disorders (n=127) were asked to sustain the vowel [a:] and read aloud the Turkish phonetically balanced text. To determine the test-retest reliability of AVQI, 20 dysphonic (ie, around 15% of the group), and 20 normophonic (ie, around 15% of the group) were reassessed 15 minutes after the first AVQI determination. A three middle seconds of sustained vowel [a:] and a sentence with 25 syllables was concatenated, and AVQI analysis was conducted. The auditory-perceptual evaluation was performed by five experienced raters with Grade (G) from GRBAS Protocol. There was a statistically significant correlation between AVQI scores and auditory-perceptual evaluation of overall voice quality (rs=0.717, P < 0.001). AVQI gave a threshold of 2.98 for the dysphonic voice. The values of intraclass correlation coefficient with two-way mixed-effects model, single-measures type, absolute agreement definition showed an excellent test-retest reliability for AVQI in Turkish language (intraclass correlation coefficient=0.986). AVQI v.02.06 is a valid and robust tool in differentiating dysphonic and normal voice, and has excellent test-retest reliability in Turkish language.

The validity of the Acoustic Breathiness Index in the evaluation of breathy voice quality: A Meta-Analysis.

The evaluation of voice quality with acoustic measurements is useful to objectify the diagnostic process. Particularly, breathiness was highly evaluated and the Acoustic Breathiness Index (ABI) might have promising features. The goal of the present meta-analysis is to quantify, from existing cross-validation studies, the evidence for the diagnostic accuracy of ABI, including its sensitivity and specificity. Meta-analysis. We searched in MEDLINE, Google Scholar and Science Citation Index, and as manual search for the term Acoustic Breathiness Index from inception to February 2020. Studies were included that used equal proportion of continuous speech and sustained vowel segments, a recording hardware with a sufficient standard for voice signal analyses, the software Praat for signal processing and the customised Praat script, and two groups of subjects (vocally healthy and voice-disordered). Furthermore, the diagnostic accuracy of ABI was measured. The primary outcome variable was ABI. The score ranged from 0 to 10 with varying thresholds according to different languages to determine the absence or presence of breathiness. A meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses of diagnostic test accuracy study guidelines. Data were extracted, and the risk of bias was assessed using the QUADAS-2 tool. The pooled sensitivity and specificity of ABI were determined using a summary receiver operating characteristic (SROC) approach to calculate also a weighted threshold value of ABI with its sensitivity and specificity. A total of 34 unique citations were screened, and 10 full-text articles were reviewed, including six studies. In total, 3603 voice samples were considered for further analysis separating into 467 vocally healthy and 3136 voice-disordered voice samples. The pooled sensitivity was 0.84 (95% CI, 0.83-0.85), and the pooled specificity was 0.92 (95% CI, 0.89-0.94). The area under the curve of the SROC curve of this analysis showed an excellent value of 0.94. The weighted ABI threshold was determined at 3.40 (sensitivity: 0.86, 95% CI, 0.84-0.87.; specificity: 0.90, 95% CI 0.88-0.92). The results confirm the ABI as robust and valid objective measure for evaluating breathiness.

Respiratory Muscle Strength Training to Improve Vocal Function in Patients with Presbyphonia

The effects of presbyphonia are compounded by the decline in respiratory function that occurs with age. Commonly recommended exercises to optimize the use of respiratory muscles during speech, such as diaphragmatic breathing, are unlikely to be intensive enough to induce respiratory changes and impact vocal function. The objective of this study was to assess the effect of adding a targeted intervention, respiratory muscle strength training, to voice exercises in a sample of patients with presbyphonia. In this prospective, randomized-controlled trial, 12 participants received either (1) vocal function exercises (VFE), (2) VFE combined with inspiratory muscle strength training (IMST), or (3) VFE combined with expiratory muscle strength training (EMST). Data collected prior to and following 4 weekly intervention sessions included respiratory measures (pulmonary function and respiratory muscle strength) and voice measures (videostroboscopy, acoustic, auditory-perceptual, aerodynamic, and self-assessment measures). Participants who received IMST improved their voice quality during connected speech (smoothed cepstral peak prominence and ratings of overall voice quality) and their scores on the three self-assessment questionnaires with large to very large within-group effect sizes (|d|=0.82-1.61). In addition, participants in the IMST group reduced their subglottal pressure with a large effect size (d=-0.92). Participants who received EMST improved their maximum expiratory strength and smoothed cepstral peak prominence with large effect sizes (d=0.80 and 0.99, respectively) but had limited improvements in other outcomes. Participants who received only VFE decreased their amount of vocal fold bowing, improved their voice quality on a sustained vowel (amplitude perturbation quotient), and improved their Glottal Function Index score with large effect sizes (|d|=0.74-1.00). Preliminary data indicate that adding IMST to voice exercises may lead to the greatest benefits in patients with presbyphonia by promoting improved subglottal pressure control as well as increasing air available for phonation, resulting in improved self-assessment outcomes.

여성 노인 합창단원의 합창단 유형에 따른 청지각적 음성평가(GRBAS) 및 음성관련 삶의 질(K-VRQOL) 비교*

The purpose of this study is to compare voice characteristics and voice-related quality of life (K-VRQOL) of the elderly female choir members using perceptual-auditory voice quality evaluation (GRBAS) and K-VRQOL scales. The participants were 77 women over 60 years old who were actively engaged in the choir in either Seoul or Busan. There are two kinds of choirs that indicate different engagement levels: regular choir and church choir. The perceptual-auditory vocal quality evaluation was listened to by / a / vowels and were graded by experts using the GRBAS scale. As a result, when comparing the differences between groups, the elderly female participants of the regular choir showed higher satisfaction in speech using the subjective speech recognition level than the elderly female members who performed in the church choir. In addition, the analysis showed that the satisfaction level was high in the physical function area of the K-VRQOL scale. This study confirmed that choral activities could yield positive results not only in terms of improving voice function in old age, but also to improve the subjective perception level of voice use, thus suggesting the necessity of systematic music programs to improve voices that are aging.

Vocal Function Differences Before and After Sorority Recruitment

Participation in sorority recruitment often results in acute vocal impairment. The purpose of this investigation was to characterize the extent to which voice function and laryngeal appearance may be altered by participation in this social phenomenon. Using a within-participant repeated measures design, nine women participating as sorority recruiters completed the study protocol. The following data were collected at two time points, immediately before and after the completion of two weeks of sorority recruitment: stroboscopic laryngeal imaging, vocal acoustic measures, and perceptual measures of vocal effort and voice quality. Perceived phonatory effort and overall severity of voice quality were significantly impaired following sorority recruitment. All participants had evidence of mucosal changes in the form of one or more the following: observed edema, erythema, increased vascularity, glottic margin changes. No significant differences in acoustic measures were identified. Increased perceived vocal effort, increased overall severity ratings of voice quality, and deleterious vocal fold tissue changes observed support the hypothesis that the acute vocal loading that is characteristic of the sorority recruitment process contributes to a decline in voice function in the short term. Acoustic measures taken either lacked the sensitivity for the perceived decline in voice function or the participants, who were otherwise healthy, managed to adapt the acoustic signal to the tissue changes observed. The extent to which these acute changes may be mitigated with vocal hygiene and voice training is an area for future study.

Outcomes of voice therapy in children with benign vocal fold lesions

ObjectiveThis study aims to examine the effect of voice therapy on dysphonia on children with benign vocal fold lesions, as measured by perceptual evaluation using the Consensus Auditory Perceptual Evaluation of Voice (CAPE-V) and acoustic and aerodynamic measures (jitter, shimmer, noise-to-harmonic ratio, phonation threshold pressure, mean airflow during voicing, subglottic pressure during comfortable phonation). Study designProspective disease-specific outcomes database. MethodsSubjects identified in the database consisted of 28 children (14 male, 14 female) between the ages of three and eighteen. Pre- and post-therapy perceptual, acoustic and aerodynamic measures were compared using two-sided paired t-test. ResultsThere was a statistically significant difference in perceptual ratings of voice quality (p < .001) and in phonation threshold pressure before and after therapy (p = .034). While acoustic measures improved after therapy, changes were not statistically significant. ConclusionsChildren with dysphonia secondary to benign vocal fold lesions showed positive change in perceptual ratings of voice quality and in phonation threshold pressure after voice therapy.

Effects of Voice Quality Improvement Program for Professional Voice Users with Functional Voice Disorders

Background/Objectives: One of the most emphasized aspects in voice therapy is voice quality. We investigated the effect of our intervention program on improving voice quality and reducing vocal fatigue.Method/Statistical Analysis: 10 musical actors/actresses with functional voice disorders were given eight training sessions once a week, and both subjective and objective evaluations of their voices were conducted before and after the training. K-SVHI and VFI were used to measure voice handicap index and voice fatigue index. Praat was used to measure the objective acoustic indices. To examine the statistical significance, a paired sample t-test was performed.Findings: The result of subjective voice quality evaluation showed that both scores of voice handicap index and voice fatigue index were decreased. The objective voice evaluation results showed that the jitter (%) and shimmer(%) scores decreased while the harmonics to noise ratio (HNR) and the speaking fundamental frequency (SF0) scores increased. The lower the jitter and shimmer, the better the quality of voice, while the higher the HNR, the better the quality of voice.The difference between pretest and posttest scores was statistically significant except for the SF0. The reason for small changes in the SF0 seems to be that all participants of musical actor/actresses who skillfully use the voice were able to control their voice to maintain the frequency at a certain level.Improvements/Applications: Our findings indicate that patients with functional voice disorders have problems ways to use their voice and showed that their voice quality and vocal fatigue can be improved by modifying and training four stages of voice production.

Proposal for a Core Outcome Set of Measurement Instruments to Assess Quality of Voice in Adductor Spasmodic Dysphonia Based on a Literature Review

Uniform evaluation of treatment effect on the quality of voice in adductor spasmodic dysphonia (AdSD) is challenging due to the broad variety of available outcome measurement instruments (OMIs). The European Laryngological Society categorized five types of measurement domains for voice quality evaluations: patient-reported outcome measures, perceptual analyses, acoustic analyses, visual analyses, and aerodynamic measurements. The aim of this study was to propose a core outcome set (COS) for these domains, enabling systematic assessments of treatment effects on the quality of voice in patients with AdSD. The PubMed, Embase, and Cochrane databases were searched for eligible studies published before July 2019. The results were systematically analyzed following the protocol of the COnsensus-based Standards for the selection of health Measurement INstruments/Core Outcome Measures in Effectiveness Trials initiative. The proposed COS is based on the prevalence of OMIs, quality of the included studies, criteria for good measurement properties, and correlations to other OMI domains. A total of 76 articles were included, with nearly all studies and OMIs found to be of moderate or low quality. The 19 studies that reported on the correlation of OMIs demonstrated conflicting results. Appraising the best available evidence, our proposed COS consisted of patient-reported outcome measures (voice handicap index), perceptual measurements (grade, roughness, breathiness, strain, and voice breaks) and acoustic measurements (voice breaks, voice onset time, aperiodicity, and multiparameter algorithms). A review of OMIs evaluating treatment effects in AdSD was conducted. Based on this review, a uniform COS was proposed. However, evidence for the selected instruments was limited. Further exploration into the validity and reliability of OMIs for AdSD is recommended.

Acoustic Voice Quality Index and Acoustic Breathiness Index as two examples for strengths and weaknesses of free software in medicine

ObjectiveThe purpose of the study was to explore the extent to which different Praat versions affect the reproducibility of results performing Acoustic Voice Quality Index (AVQI) and Acoustic Breathiness Index (ABI). MethodSeven Praat versions were selected and categorized into three groups based on hierarchical cluster analysis. The differences/distances, diagnostic accuracy, and concurrent validity were evaluated among the three groups. Group three had just one Praat version. This version was found after two month to have a computation bug in smoothed cepstral peak prominence (i.e., an important measure for AVQI and ABI) before a new update removed this bug. For the analyses, a previous database of 218 German voice samples and auditory-perceptual judgment results were used. ResultsThe AVQI and ABI results between group 1 and 2 (p = 0.53, and p = 0.62, respectively) demonstrated no significant differences. However, the results between these two groups and group 3 yielded significant differences for AVQI and ABI (all p < 0.00001). The concurrent validity for AVQI (r = 0.84 to 0.86) and ABI (r = 0.84 to 0.85) were strong in all three groups. The diagnostic accuracy of both indices was also sufficient for group one and two but low in group three particularly in sensitivity (AVQI: 23% and ABI: 9%, respectively). ConclusionAVQI and ABI are two robust measurements in the evaluation of voice quality. However, caution is warranted using updates in open source software such as Praat for patient care or research.

Predicting Intelligibility Deficits in Parkinson's Disease With Perceptual Speech Ratings.

Purpose This study investigated whether perceptual ratings of speech parameters were predictive of transcription intelligibility in quiet and in noise for speakers with Parkinson's disease (PD). Method Ten speakers with PD and five healthy controls read 56 sentences. One group of 60 listeners orthographically transcribed the sentences in quiet, and another group of 60 listeners transcribed in noise. An additional 23 listeners judged a variety of speech parameters, including articulation, prosody, resonance, voice quality, and ease of understanding on a visual analog scale. Scores of the visual analog scale ratings were regressed against transcription intelligibility in quiet and in noise. Results Perceptual ratings of all the speech parameters were lower for speakers with PD. Global speech understanding, indexed by ease of understanding ratings, was associated with transcription intelligibility in quiet and in noise with a stronger effect in noise. Among the rated speech parameters, ease of understanding and voice quality ratings were significant predictors of speech intelligibility in noise. Conclusions Speech in individuals with PD was more difficult for listeners to understand and was characterized by deficits in articulation, prosody, resonance, and voice quality compared to normal speech produced by healthy older adults. Ease of understanding ratings, even when performed in quiet, predicted intelligibility in noise. Poor voice quality ratings in PD, a sign of phonatory deficit, had a negative impact on intelligibility in noise for speakers with PD.

Perception and Acoustic Studies of Vowel Intelligibility in Dysphonic Speech

This study aimed to (1) examine the effect of dysphonia and background noise on the identifiability of vowels, and (2) evaluate the relationship between the degree of vowel intelligibility and vowel-related acoustic measurements. A speech perception experiment was conducted with speech samples collected from 10 adult females with healthy voices and 10 adult females with dysphonia. The speech material was 11 vowels of American English in /h/-vowel-/d/ format. Cafeteria noise was added to these samples at a signal-to-noise ratio of -6 dB. A total of 10 adults with normal hearing participated in a speech perception experiment, in which the vowels were presented with and without the noise. F1 and F2 frequencies of the vowels were measured, and their relationships with the vowel intelligibility were statistically evaluated. The group-level analysis showed that vowel intelligibility was lower in dysphonic speech than normal speech, both in quiet and at signal-to-noise ratio of -6 dB. The intelligibility was higher for the high vowels than the low vowels. In general, the vowel confusion pattern was similar between normal and dysphonic speech. However, data from a speaker with severe diplophonia showed a distinct confusion pattern. Voice quality ratings did not significantly correlate with the vowel intelligibility. There was a significant correlation between F2 and the vowel intelligibility in quiet. A post-hoc acoustic analysis revealed that vowels of the speakers with lower vowel intelligibility had lower acoustic energy above 1 kHz. Dysphonia negatively affects vowel intelligibility. Low vowels were more vulnerable to the effect of dysphonia than high vowels. Among different types of dysphonic voice qualities, diplophonia appears to be particularly detrimental to vowel intelligibility. F2 significantly correlated with vowel intelligibility; however, this result requires a careful interpretation. Given that the acoustic energy above 1 kHz resulted in better intelligibility in noise, a treatment strategy that targets this frequency region may help improve intelligibility in noise. Future studies should examine the generalizability of this finding to different age and gender groups, and intelligibility as a whole.

Speech Intelligibility During Clinical and Low Frequency.

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) has become an effective and widely used tool in the treatment of Parkinson’s disease (PD). STN-DBS has varied effects on speech. Clinical speech ratings suggest worsening following STN-DBS, but quantitative intelligibility, perceptual, and acoustic studies have produced mixed and inconsistent results. Improvements in phonation and declines in articulation have frequently been reported during different speech tasks under different stimulation conditions. Questions remain about preferred STN-DBS stimulation settings. Seven right-handed, native speakers of English with PD treated with bilateral STN-DBS were studied off medication at three stimulation conditions: stimulators off, 60 Hz (low frequency stimulation—LFS), and the typical clinical setting of 185 Hz (High frequency—HFS). Spontaneous speech was recorded in each condition and excerpts were prepared for transcription (intelligibility) and difficulty judgements. Separate excerpts were prepared for listeners to rate abnormalities in voice, articulation, fluency, and rate. Intelligibility for spontaneous speech was reduced at both HFS and LFS when compared to STN-DBS off. On the average, speech produced at HFS was more intelligible than that produced at LFS, but HFS made the intelligibility task (transcription) subjectively more difficult. Both voice quality and articulation were judged to be more abnormal with DBS on. STN-DBS reduced the intelligibility of spontaneous speech at both LFS and HFS but lowering the frequency did not improve intelligibility. Voice quality ratings with STN-DBS were correlated with the ratings made without stimulation. This was not true for articulation ratings. STN-DBS exacerbated existing voice problems and may have introduced new articulatory abnormalities. The results from individual DBS subjects showed both improved and reduced intelligibility varied as a function of DBS, with perceived changes in voice appearing to be more reflective of intelligibility than perceived changes in articulation.

Predictive Value of Auditory Perceptual Assessment of Voice in Diagnosis of Functional Voice Disorders and Minimal Associated Pathological Lesions

Background: Auditory perceptual assessment is considered the preliminary assessment tool of disordered voice quality. The validity of perceptual measurement depends on characteristics of the raters and the stimuli. It is associated with minimal cost and no specialized instrumentation is required. Because auditory-perceptual evaluation of dysphonia has been heavily criticized on the basis of its reliability and validity, we conducted this study to assess the reliability of auditory perceptual assessment as one of the objective measures for assessment of voice disorders and to determine the predictive relationships between instrumental measures as endoscopic examination and perceptual ratings of impaired voice quality. Subjects and Methods: The study included 50 patients complaining of dysphonia with age ranges from 5 -61 years. Auditory perceptual assessment (APA) of patients’ voices was done and voice recordings were assessed by three experienced phoniatricians in a double blind, randomized fashion. The examiners (Ex1.2.3) assessed the recorded voice quality by using the modified GRBAS scale. Laryngoscopic examination was performed using indirect laryngoscope, flexible fibrotic laryngoscopy as well as rigid laryngoscope. Results: Results showed considerable similarities among raters in assessing the disordered voice quality especially on assessing the overall grade of dysphonia and the “Strain” voice quality with strong inter-rater reliability (Cronbach's Alpha) was 0.780 and 0.710 respectively. However, data showed some differences with poor inter-rater reliability especially for ratings of glottal attack and associated laryngeal function as cough (Cronbach's Alpha) was 0.383 and 0.531 respectively. The study also showed significant relations on comparing between instrumental (video endoscopic) diagnosis and perceptual predictive diagnosis of patients’ disordered voice quality according to two of the raters with P <0.03&0.04. Conclusion: This study showed considerable variability of the inter-rater reliability across parameters of disordered voice quality with high inter-rater reliability for some parameters and low for others. Yet, there was a strong association between instrumental diagnostic measures and the perceptual predictive diagnosis denoting a clear relationship between listener’s judgments of disordered voice quality and the underlying vocal pathology; a thing that is in favor for the validity of APA as a popular and fundamental tool for the assessment of vocal impairment.

Validation of the Dysphonia Severity Index in the Dr. Speech Program

PurposeThe Dysphonia Severity Index (DSI) is an objective multiparameter index of voice quality that measures and describes overall voice quality. Some studies have suggested that the reliability of devices for DSI measurement should be examined. We explored the feasibility of DSI measurements using the Dr. Speech (DRS) device, verified its effectiveness for clinical voice measurements and intradevice reliability, and examined the correlation between the DSI and self-evaluations of voice problems. MethodsSeventy adult participants (including individuals with voice problems and healthy adults) underwent objective and subjective voice assessments. These data were then used to establish a DSIDRS model and test the intradevice (DRS device and Praat software) reliability. The clinical validation of the DSIDRS was conducted by measuring the DSI of six other participants and comparing the observed and predicted perceived voice quality as expressed by the G score (of the GRBAS scale). Moreover, the relationship between the DSI measurements and participants’ self-evaluations of voice problems was investigated by analyzing the correlation between the DSI and the Voice Handicap Index (VHI). ResultsThe DSIDRS discriminated 80% of participants’ voice quality ratings. There were strong correlations between the DSI and variables measured by the DRS device and Praat software. Furthermore, there was no significant correlation between the DSIDRS and VHI. ConclusionThe DRS device can perform DSI measurements. Objective voice measurements and perceptual voice ratings reflected different aspects of vocal function and its effects. These factors should be considered in clinical practice settings.

Validation of the Measures of Cepstral Peak Prominence as a Measure of Dysphonia Severity in Spanish-Speaking Subjects

Introduction and objectivesPerceptual rating of overall voice quality and other more specific perceptual dimensions is difficult, as such judgments depend on the listener's subjectivity. Thus, finding objective, valid, and accessible clinical measures to include in comprehensive voice evaluation protocols is a priority.The purposes of this study were to (1) determine the diagnostic accuracy of a single acoustic measure, smoothed cepstral peak prominence (CPPS), to predict voice disorder status from sustained vowels and connected speech samples using the software Praat; (2) to determine the relationship between measures of CPPS and perceptual ratings of vocal quality; and (3) describe the normative values of CPPS. MethodMeasures of CPPS were obtained from connected speech and sustained vowel recordings of 72 Spanish-speaking subjects with voice disorders and 52 nondysphonic Spanish-speaking subjects with no vocal disorders using freely downloadable Praat software. IBM SPSS Statistics software version 23 was used to complete the statistical analyses. ResultsResults revealed a 70% sensitivity rate, a specificity rate of 85%. Estimated severity for sustained vowels and connected speech were strongly correlated and significantly associated with listener ratings of dysphonia severity. ConclusionsA single acoustic measure of CPPS was highly predictive of voice disorder status using Praat software. Clinicians may consider using CPPS to complement clinical voice evaluation and screening protocols.

Evaluation of Voice Quality in Patients With Vocal Fold Polyps: The Size of a Polyp Matters or Does it?

ObjectiveThis study aimed to investigate the correlation between morphological features of vocal fold polyps (VFPs) and subjective/objective voice parameters. MethodsPerceptual evaluations, aerodynamic and acoustic tests were performed on 47 patients with VFPs. Still images were captured from video and the morphological features associated with the size of VFP were quantified. To reveal the correlation between size-related morphological features (length of polyp base, the ratio of polyp base to vocal fold length, glottal gap area) and objective/subjective parameters of voice, Pearson's and Spearman's tests were carried out. ResultsThis cohort was composed of 30 (63.8 %) male and 17 (36.2%) female patients with the mean age of 45.2 years and 41.3 years, respectively. No correlation was found between the morphological features of VFPs and any of perceptual, aerodynamic and acoustic voice parameters. ConclusionsOur findings indicated that controversies still exist regarding the role of vocal fold polyp morphology in clinical decision making.