Evaluation Of Voice Quality Research Articles

Effect of Dysphonia and Cognitive-Perceptual Listener Strategies on Speech Intelligibility

There is a high prevalence of dysphonia among professional voice users and the impact of the disordered voice on the speaker is well documented. However, there is minimal research on the impact of the disordered voice on the listener. Considering that professional voice users include teachers and air-traffic controllers, among others, it is imperative to determine the impact of a disordered voice on the listener. To address this, the objectives of the current study included: (1) determine whether there are differences in speech intelligibility between individuals with healthy voices and those with dysphonia; (2) understand whether cognitive-perceptual strategies increase speech intelligibility for dysphonic speakers; and (3) determine the relationship between subjective voice quality ratings and speech intelligibility. Sentence stimuli were recorded from 12 speakers with dysphonia and four age- and gender-matched typical, healthy speakers and presented to 129 healthy listeners divided into one of three strategy groups (ie, control, acknowledgement, and listener strategies). Four expert raters also completed a perceptual voice assessment using the Consensus Assessment Perceptual Evaluation of Voice for each speaker. Results indicated that dysphonic voices were significantly less intelligible than healthy voices (P ≤ 0.001) and the use of cognitive-perceptual strategies provided to the listener did not significantly improve speech intelligibility scores (P = 0.602). Using the subjective voice quality ratings, regression analysis found that breathiness was able to predict 41% of the variance associated with number of errors (P = 0.008). Overall results of the study suggest that speakers with dysphonia demonstrate reduced speech intelligibility and that providing the listener with specific strategies may not result in improved intelligibility.

A new online Bayesian NMF based quasi-clean speech reconstruction for non-intrusive voice quality evaluation

Voice quality evaluation under complex environments is an important part of Quality of Service. Recently, the non-intrusive evaluation is a challenging problem and is getting more and more attentive. Since the traditional non-intrusive evaluation has no knowledge of the original clean speech, it is expected to be underperformed the intrusive one. In this paper, a new non-intrusive method based on quasi-clean speech reconstruction and intrusive model is proposed. To obtain the quasi-clean speech, a new online Bayesian non-negative matrix factorization (NMF) based speech reconstruction algorithm is presented. The noise basis matrix is updated utilizing the noise frames from the online noisy observation, and the quasi-clean speech is reconstructed using the Bayesian NMF in combination of speech activity probability. The final reconstructed signal is regarded as the reference of the modified Perceptual Evaluation of Speech Quality (PESQ) model to achieve the noisy speech quality. The experiment results show that the proposed method obtains a 0.895 correlation on NOIZEUS and ITU-T P-series Supplement 23 database, which is 10.1% outperforms non-intrusive standard ITU-T P.563.

Effects of Deep Brain Stimulation of the Subthalamic Nucleus Settings on Voice Quality, Intensity, and Prosody in Parkinson's Disease: Preliminary Evidence for Speech Optimization.

To systematically evaluate how different deep brain stimulation of the subthalamic nucleus (STN-DBS) amplitude, frequency, and pulse-width electrical parameter settings impact speech intensity, voice quality, and prosody of speech in Parkinson's disease (PD). Ten individuals with PD receiving bilateral STN-DBS treatments were seen for three baseline and five treatment visits. The five treatment visits involved an examination of the standard clinical settings as well as manipulation of different combinations of frequency (low, mid, and high), pulse width (low, mid, and high), and voltage (low, mid, and high) of stimulation. Measures of speech intensity, jitter, shimmer, harmonics-noise ratio, semitone standard deviation, and listener ratings of voice quality and prosody were obtained for each STN-DBS manipulation. The combinations of lower frequency, lower pulse width, and higher voltage settings were associated with improved speech outcomes compared to the current standard clinical settings. In addition, decreased total electrical energy delivered to the STN appears to be associated with speech improvements. This study provides preliminary evidence that STN-DBS may be optimized for Parkinson-related problems with voice quality, speech intensity, and prosody of speech.

Management of laryngeal papillomatosis using coblation: another option of surgical intervention.

Recurrent respiratory papillomatosis is a disease caused by the human papilloma virus (HPV). HPV is frequently localised in the larynx. The disease tends to recur and frequent intervention is usually required. Management modules include surgical intervention using microdebriders or laser ablation as well as adjuvant treatments which aim mainly at maintaining an adequate airway and secondly to manage dysphonia caused by the growth on the vocal folds. In this pilot study, another surgical modality is trialled using plasma-mediated radio-frequency ablation (coblation). Retrospective study examining management of 15 adult patients diagnosed with recurrent laryngeal papillomatosis and surgically treated using coblation. One patient required multiple procedures. Pre-operative assessment in voice clinic evaluating voice quality and its impact on patients' life-quality using voice parameters and self-assessment questionnaires. Follow-up post-operatively using the same parameters from 4 to 6 weeks after surgery until up to 2years later to check recurrence rate. No other adjuvant treatment was used and all patients received post-operative voice therapy. 78.6% of patients did not show evidence of recurrence during the study period. Improvement in voice handicap following first intervention is reported and recurrence rate in the rest of the sample reported. The results of this small sample seem to support the previous small studies' findings that coblation is a good excisional technique to use for removal of laryngeal papillomatosis. Recurrence rates seem to be slightly lower than rates reported in the literature for the other surgical modalities. IV.

Repetitive Voice Evaluation in Dysphonic Teachers: Office Versus Home

A patient's voice can vary from one moment to another, and these variations cannot be captured by a one-time assessment. Multiple assessments may give a more holistic idea of the severity of the patient's dysphonia and by asking the patient to do the recordings he becomes involved in his therapeutic plan from the beginning. This study aims to evaluate the added value of a repetitive assessment outside the speech therapist's (SLP) clinic, to have a broader vision of the voice disorder and identify parameters that change after working hours to be able to explain this disorder and find solutions for it. Twelve dysphonic Lebanese teachers, aged between 20 and 60 years, recorded their voices once at the SLP's office, and five other times at home every day after working hours. The recordings included a standardized text and a sustained /ɑ/. For perceptive evaluation of voice quality, six SLPs (three experts and three naïve) analyzed the recordings using the GRBAS scale. For self-assessment, patients filled two self-assessment grids at the office: (SSVS: subjective assessment for vocal overwork) and the Lebanese Voice Handicap Index (VHI-10lb) questionnaire. They responded orally to a third scale ranging from 0 to 100 assessing the severity of dysphonia every day after completing the repetitive home recordings. For objective evaluation of the acoustic parameters, PRAAT software was used. Results reveal significant difference between the scores of the voices recorded in the office compared to the home repetitive assessment for the G and R of the perceptual evaluation with P < 0.01, as well as for the Jitter, the fundamental frequency, and the harmonic-to-noise ratio with P < 0.05. The recordings made at home revealed a more severe dysphonia. The self-evaluation scales 1 and 2 (VHI-10Ib, SSVS) did not correlate with the results of the objective and perceptual analysis, whereas the results of the oral self-assessment 3 seem to be in agreement with the results of Jitter (P < 0.05), and Grade of dysphonia (P < 0.05). In teachers, the severity of dysphonia is more pronounced when the voice is recorded after working hours. Daily self-evaluation allows the patient to be more aware of his vocal disorder and voice fluctuations and might improve participation and compliance with therapy. It may also be used to monitor the response to speech therapy.

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.

Subjective and objective assessment of voice quality in pregnancy.

During pregnancy, voice quality disorders may occur in form of: edema, dryness, nervousness. The aim of the study is subjective and objective evaluation of voice quality in pregnant women. The study included 20 women in the third trimester of pregnancy, age of 20-31 diagnosed at the Department of Clinical Phonoaudiology and Logopedics, Medical University of Bialystok. Subjective assessment has been based on the GRBAS scale. Objective assessment of the vocal organ used the HSDI technique (High Speed Digital Imaging). In the laryngeal visualization, high-speed camera (HS) using rigid endoscope with 90 ° optics has been used. Vibration of vocal folds has been recorded during phonation of vowel &quot;e&quot; at 4000 frames / sec. The glottal closure (GTs), symmetry, regularity and synchronization of vocal folds vibration have been assessed. In estimating the degree of glottal insufficiency, kymography of the larynx has been performed by analyzing the value of Open Quotient (OQ). Objective acoustic evaluation of voice has been also conducted using DiagnoScope Specjalista Program. Hoarseness has been observed in 15 pregnant women, whereas voice fatigability in 20 patients. Using HSDI, the edema of vocal folds in part of the group has been observed. Decreased MPT has been found in all examined women in the third trimester of pregnancy. Hoarseness and fatigability of voice are the most frequent subjective symptoms of voice organ in the third trimester of pregnancy. Decreased MPT is recorded objectively, as well as edema and insufficiency of vocal folds using HSDI technique.

Voice Therapy Outcome—A Randomized Clinical Trial Comparing Individual Voice Therapy, Therapy in Group, and Controls Without Therapy

ObjectiveA stumbling-block in voice therapy is how the patient will be able to apply the new voice technique in everyday life. Possibly this generalization process could be facilitated by giving voice therapy in group because of the natural forum for training voice-to-speech early in communication between the patients in a group setting. The aim of the study was to compare treatment results from individual voice therapy and voice therapy in group, at several time points and in comparison to patients with no voice therapy. MethodsA randomized treatment study was performed with 77 consecutive patients diagnosed with a functional voice disorder. Thirty-one patients were randomized to individual and group therapy, respectively, and 15 patients to no therapy. The assessments included standardized voice recording and registration of voice range profile (VRP), answering Voice handicap index (VHI) and visual analogue scales for self-hoarseness and self-vocal fatigue, and perceptual voice evaluation by speech-language pathologist. The assessments were performed before, direct after therapy, and three months later in all groups. The 2 therapy groups were also assessed 12 months after therapy. ResultsAll VHI scores as well as the self-ratings of hoarseness and vocal fatigue, and the perceptual evaluation of voice quality and maximum VRP improved significantly in both therapy groups 3 months after treatment and at 12 months follow-up. There were no significant changes in the control group, with the exception of decreased self-rated hoarseness and increased maximum VRP. Comparisons between treatment groups showed significant larger improvement after group therapy for VHI physical subscale at 12 months, as well as significant lower VHI total score at all measurement sessions and lower subscale scores at 12 months. There were no differences between treatment groups in self-hoarseness or self-vocal fatigue and no difference in perceptual voice quality or VRP. Comparison between controls and treatment groups showed significant larger change in treatment groups from baseline to three months in VHI total and to end of therapy in functional subscale. Treatment groups also showed significant lower scores than controls at each measurement session, for VHI total and physical subscale as well as lower degree of perceptual aberration of voice quality and vocal fatigue, at three months follow-up. ConclusionsThis study shows long-term improvement from behavioral voice therapy, particularly in a group setting. The results indicate the importance of early transfer-to-speech and late posttherapy test to capture whether the goal of voice therapy was fulfilled or not for the patients.

Voice Quality as Therapeutic Outcome in Laryngopharyngeal Reflux Disease: A Prospective Cohort Study

To study the usefulness of voice quality as therapeutic outcome in laryngopharyngeal reflux disease. A total of 80 patients with reflux finding score (RFS) > 7 and reflux symptom index (RSI) > 13 were treated with pantoprazole, diet, and lifestyle recommendations for 3 months. The therapeutic effectiveness was assessed with RSI; RFS; Voice Handicap Index; blinded Grade, Roughness, Breathiness, Asthenia, Strain, and Instability (GRBASI); aerodynamic and a panel of acoustic measurements before and after treatment. A correlation analysis between symptoms, videolaryngostroboscopic signs, and acoustic measurements was conducted. Compared to baseline, means of RSI, RFS, Voice Handicap Index, perceptual dysphonia, and roughness significantly decreased. Significant improvements of phonatory quotient, percent jitter, percent shimmer, Relative Average Perturbation, Pitch Perturbation Quotient, Phonatory F0 Range, Amplitude Perturbation Quotient, smooth Amplitude Perturbation Quotient, and Peak-to-Peak Amplitude Variation were found at the end of treatment. Studies of correlation did not identify relevant correlation between videolaryngostroboscopic signs, especially vocal folds edema, and objective voice quality evaluations. Voice quality assessments can help to better understand voice disorders and can be used as indicators of the treatment effectiveness in patients with laryngopharyngeal reflux-related symptoms.

Perceptual Evaluation of Voice Disorder in Children Who Have Had Laryngotracheal Reconstruction Surgery and the Relationship Between Clinician Perceptual Ratingof Voice Quality and Parent Proxy/Child Self-Report of Voice-Related Quality of Life

Reliability of the GRBAS tool for perceptual evaluation of paediatric voice disorder is measured in this study of children with a history of laryngotracheal reconstruction surgery (LTR). Additionally, the relationship between parent proxy/child self-report of voice-related quality of life with clinician perceptual rating of voice quality is analysed. Eleven children with a history of LTR provided voice recordings following the stimuli set by the CAPE-V protocol. Subjective impact of voice quality on life was measured using the paediatric voice-related quality of life questionnaire. Four trained judges rated the sound files according to both the GRBAS and CAPE-V protocol. Intra-class correlation coefficients were high for both intra-rater and inter-rater judgments across all parameters of the GRBAS protocol, and a strong correlation was found between the grade rating of the GRBAS and the overall severity rating of the CAPE-V. Some elements of parent proxy reporting of voice-related quality of life were significantly negatively correlated with clinician perceptual rating of voice quality, while there was no significant relationship between child self-report and clinician perceptual rating.

Voice Disorder Detection via an m-Health System: Design and Results of a Clinical Study to Evaluate Vox4Health.

Objectives The current study presents a clinical evaluation of Vox4Health, an m-health system able to estimate the possible presence of a voice disorder by calculating and analyzing the main acoustic measures required for the acoustic analysis, namely, the Fundamental Frequency, jitter, shimmer, and Harmonic to Noise Ratio. The acoustic analysis is an objective, effective, and noninvasive tool used in clinical practice to perform a quantitative evaluation of voice quality. Materials and Methods A clinical study was carried out in collaboration with medical staff of the University of Naples Federico II. 208 volunteers were recruited (mean age, 44.2 ± 13.9 years), 58 healthy subjects (mean age, 36.7 ± 13.3 years) and 150 pathological ones (mean age, 47 ± 13.1 years). The evaluation of Vox4Health was made in terms of classification performance, i.e., sensitivity, specificity, and accuracy, by using a rule-based algorithm that considers the most characteristic acoustic parameters to classify if the voice is healthy or pathological. The performance has been compared with that achieved by using Praat, one of the most commonly used tools in clinical practice. Results Using a rule-based algorithm, the best accuracy in the detection of voice disorders, 72.6%, was obtained by using the jitter or shimmer value. Moreover, the best sensitivity is about 96% and it was always obtained by using jitter. Finally, the best specificity was achieved by using the Fundamental Frequency and it is equal to 56.9%. Additionally, in order to improve the classification accuracy of the next version of the Vox4Health app, an evaluation by using machine learning techniques was conducted. We performed some preliminary tests adopting different machine learning techniques able to classify the voice as healthy or pathological. The best accuracy (77.4%) was obtained by the Logistic Model Tree algorithm, while the best sensitivity (99.3%) was achieved using the Support Vector Machine. Finally, Instance-based Learning performed the best specificity (36.2%). Conclusions Considering the achieved accuracy, Vox4Health has been considered by the medical experts as a “good screening tool” for the detection of voice disorders in its current version. However, this accuracy is improved when machine learning classifiers are considered rather than the rule-based algorithm.

Validez de las medidas del pico cepstral para la valoración objetiva de la disfonía en sujetos de habla hispana

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.

Perceptive evaluation of the severity of dysphonia among Lebanese bilingual subjects

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Perceptive analysis of voice represents a basic and fundamental early step in the process of evaluating voice quality. Several factors seem to affect the results. Prominent among them is bilingualism, a common occurrence among Lebanese youths who frequently speak a second or third language in addition to their native tongue Arabic.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This study aims to find pertinent information for the characterization of the severity of dysphonia depending on the language spoken by Lebanese bilingual subjects. The intent is to try to appreciate if voice seems more dysphonic in the Lebanese language compared to French and English. The sample comprises twenty-two Lebanese dysphonic women, aged between twenty and sixty years. They all read a text in Lebanese Arabic and another one in French or in English, depending on the languages that they use on a regular basis. Voice recordings are rated by four expert listeners. Two listening sessions are organized using the G, R and B criteria of Hirano’s GRBAS scale. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Results show that the voice appears more dysphonic with a more pronounced roughness when reading in French for bilingual French/Arabic subjects than it is for English/Arabic persons reading in English. However, the patients speaking French and Arabic appear to be more dysphonic as a group compared to the patients speaking English and Arabic.&lt;/p&gt;&lt;p style="margin: 0in 0in 0pt; text-align: justify;"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; It is important to enlarge the number of participants to get more accurate results. However, the suggested corpus in Lebanese Arabic seems to be adapted for the evaluation of voice quality.&lt;/p&gt;

Development of Korean Standardized Sentences on Voice Quality Evaluation for Dysphonia

Development of Korean Standardized Sentences on Voice Quality Evaluation for Dysphonia

Office-Based Autologous Fat Injection Laryngoplasty for Glottic Insufficiency in Patients Under 50 Years Old

We sought to determine the outcomes of office-based autologous fat injection laryngoplasty in the treatment of patients under 50 years old with glottic insufficiency but without neurological problems or acquired organic lesions in the vocal fold. We conducted a retrospective chart review of consecutive patients under 50 years of age who underwent office-based autologous fat injection laryngoplasty for glottic insufficiency. None of the patients presented neurological problems or acquired organic lesions in the vocal fold. Videolaryngostroboscopic data, objective voice assessment, perceptual measurements of vocal quality, and subjective ratings of voice quality were evaluated before and after treatment. The 23 patients (7 men and 16 women) in this study presented significant improvements in phonatory function in terms of maximum phonation time, jitter, grade, asthenia, and Voice Handicap Index-10 (VHI-10) values at 3 months. Significant improvements in terms of jitter, noise-to-harmonic ratio, grade, roughness, breathiness, asthenia, and the VHI-10 values were also observed at 6 months. Glottic insufficiency in younger patients without neurological problems or acquired organic lesions in the vocal fold can be treated effectively using office-based autologous fat injection laryngoplasty. Significant improvements in phonatory function were observed even 6 months after surgery.

Internal Validation of the Acoustic Voice Quality Index version 03.01 und Acoustic Breathiness Index

Acoustics might have the potential to objectify voice quality (eg, hoarseness and breathiness). The Acoustic Voice Quality Index (AVQI) and the Acoustic Breathiness Index (ABI) revealed sufficient valid and reliable results in the evaluation of voice quality. The aim of the present study is to validate the recent version of AVQI 03.01 and ABI in their internal validation. The responsiveness of change is evaluated on the hoarseness and breathiness severity after voice therapy. In total, 84 voice samples of continuous speech and sustained vowel [a:] before and after a voice therapy were used. All 42 subjects presented organic and nonorganic voice disorders and various degrees of dysphonia severity before and after behavioral voice therapy. The voice samples were judged by three voice experts using the RBH-scale, which is based on the GRBAS-scale. The intra-rater reliability was high for hoarseness (mean kappa = 0.76) and breathiness (mean kappa = 0.69).The inter-rater reliability was lower for both voice quality characteristics and ranged between kappa = 0.27 to 0.29. A strong correlation was identified between the perceived rating of hoarseness and breathiness and AVQI and ABI before and after voice therapy (r = 0.715, p < 0.01, and r = 0.712, p < 0.01, respectively). Additionally, no significant differences were revealed. The present results showed that AVQI version 03.01 und ABI had a high internal validity to assess voice changes after voice therapy. AVQI and ABI are two valid and robust voice measures to objectify hoarseness and breathiness.

Treatment Outcomes and Adverse Events Following In-Office Angiolytic Laser With or Without Concurrent Polypectomy for Vocal Fold Polyps

In-office angiolytic laser procedures have been used successfully as an alternative treatment for vocal fold polyps; little is known in detail about the treatment outcomes and adverse events. To examine the outcomes and incidence rates of adverse events associated with in-office angiolytic laser procedures with or without concurrent polypectomy as an alternative treatment for vocal fold polyps. Retrospective cohort study at a tertiary medical center. We identified 114 consecutive patients with vocal polyps who underwent in-office angiolytic laser treatments between January 1, 2014, and August 31, 2016. After the exclusion of 17 with missing or incomplete data, 97 were enrolled. In-office 532-nm laser procedures with or without concurrent polypectomy. Between 1 and 2 months after the surgical procedures, we collected the following outcome data: videolaryngostroboscopy, perceptual rating of voice quality, acoustic analysis, maximal phonation time, and subjective rating of voice quality using a visual analogue scale and 10-item voice handicap index. This study enrolled 97 patients (mean [SD] age, 45.6 [11.3] years; 48 [49%] male). The mean duration of symptoms was 10.1 months (range, 1-60 months). Twenty-nine patients (30%) had angiolytic laser procedures only, while 68 (70%) received laser with concurrent polypectomy. Both treatment modalities offered significant improvements. Only 1 patient (1%) receiving angiolytic laser with concurrent polypectomy underwent another treatment session, so this group had significantly less need for multiple treatments than those receiving laser treatment alone (6 [21%]; effect size, -1.57; 95% CI, -2.77 to -0.36). We identified 8 adverse events (8% of the cases): vocal fold edema (n = 5), vocal hematoma (n = 2), and vocal ulceration (n = 1). Patients treated with laser plus concurrent polypectomy had significantly fewer adverse events than those treated with angiolytic laser alone (2 [3%] vs 6 [21%]; effect size, 1.20; 95% CI, 0.26 to 2.13). In-office angiolytic laser procedures can be an effective alternative treatment for vocal polyps, although with possible need for multiple treatment sessions and occasional occurrence of minor postoperative adverse events. Concurrent polypectomy following laser coagulation allows less laser energy delivery and reduces the risk of postoperative adverse events and the need for additional treatment sessions.

Characteristics of a Treatment-seeking Population in a Private Practice Community Voice Clinic: An Epidemiologic Study

The purpose of this study was to evaluate epidemiologic characteristics of a treatment-seeking population referred to a private practice community voice clinic. This is a retrospective cohort study. Patient files representing evaluation referrals over a 28-month period were reviewed. Variables tabulated from records included disorder diagnosis, age, gender, perceptual voice quality ratings, and self-perceived voice handicap at initial evaluation. Descriptive statistics were used to evaluate the diagnosis category and demographic patterns. Parametric statistics were applied to quantitative clinical measurements to test the effect of voice disorder category on perceptual voice quality ratings and self-perceived voice handicap. A total of 216 consecutive patient files were reviewed. Collectively, the most common disorder diagnosis was "other," consisting of a varied cluster of etiologies, including reflux laryngitis, chronic cough, bilateral paralysis or paresis, leukoplakia, and polypoid degeneration. The most common diagnosis in women was midmembranous lesions, and that in men was the "other" category followed by atrophy and bowing associated with presbylaryngis. The greatest severity and handicap measures were found in patients with unilateral paralysis. Collectively, the demographic patterns reported in this study align with those from specialty voice clinics housed in academic medical centers and community voice clinics led by laryngologists and general otolaryngologists. Translating these findings to professional practice, the data support the notion that speech-language pathologists specializing as voice therapists who seek to establish private practice clinics should possess competencies in the knowledge and skills required to serve treatment-seeking populations with a wide variety of voice impairments.

Type I thyroplasty for unilateral vocal fold palsy: Silastic or titanium implant?

Introduction: Process of speech involves adduction of true vocal cords, and their palsy results in dysphonia with or without aspiration. Medialization thyroplasty is the standard of care and involves insertion of an implant to achieve apposition. We conducted a randomized prospective study to evaluate two types of implants (Silastic vs. titanium) in terms of surgical time and perceptive, acoustic, and aerodynamic evaluation. Materials and Methods: Twenty-six patients were randomized into two groups and were implanted one type of implant. They were evaluated and compared on the basis of voice handicap index (VHI), voice quality evaluation (VQE), and maximum phonation time (MPT). Results: The mean time taken for Silastic implantation was 83.07 min and for titanium implantation was 52.16 min. VHI and VQE decreased significantly following implantation in both groups, while MPT increased in both groups significantly. There was no significant difference between two groups. Conclusion: Medialization thyroplasty with both types of implants achieves good and comparable results. Silastic implant surgery takes longer time but is relatively inexpensive.

Machine Learning Applied to GRBAS Voice Quality Assessment

Voice problems are routinely assessed in hospital voice clinics by speech and language therapists (SLTs) who are highly skilled in making audio-perceptual evaluations of voice quality. The evaluations are often presented numerically in the form of five-dimensional ‘GRBAS’ scores. Computerised voice quality assessment may be carried out using digital signal processing (DSP) techniques which process recorded segments of a patient’s voice to measure certain acoustic features such as periodicity, jitter and shimmer. However, these acoustic features are often not obviously related to GRBAS scores that are widely recognised and understood by clinicians. This paper investigates the use of machine learning (ML) for mapping acoustic feature measurements to more familiar GRBAS scores. The training of the ML algorithms requires accurate and reliable GRBAS assessments of a representative set of voice recordings, together with corresponding acoustic feature measurements. Such ‘reference’ GRBAS assessments were obtained in this work by engaging a number of highly trained SLTs as raters to independently score each voice recording. Clearly, the consistency of the scoring is of interest, and it is possible to measure this consistency and take it into account when computing the reference scores, thus increasing their accuracy and reliability. The properties of well known techniques for the measurement of consistency, such as intra-class correlation (ICC) and the Cohen and Fleiss Kappas, are studied and compared for the purposes of this paper. Two basic ML techniques, i.e. K-nearest neighbour regression and multiple linear regression were evaluated for producing the required GRBAS scores by computer. Both were found to produce reasonable accuracy according to a repeated cross-validation test.